Dural-based metastatic carcinomas mimicking primary CNS neoplasia: Report of 7 cases emphasizing the role of timely surgery and accurate pathologic evaluation

Natasha Marie Savage, Cargill Herley Alleyne, John R Vender, Ramon E Figueroa Ortiz, Hui Zhang, Thomas A. Samuel, Suash Sharma

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5 Citations (Scopus)

Abstract

Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas. Following the receipt of HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6 meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records and follow-up data were reviewed. Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and "picket-fence" like glands were among useful histologic diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases. Subsequent clinical and radiologic evaluation confirmed coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery. Although high-grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic carcinomas.

Original languageEnglish (US)
Pages (from-to)530-540
Number of pages11
JournalInternational Journal of Clinical and Experimental Pathology
Volume4
Issue number5
StatePublished - Nov 2 2011

Fingerprint

Carcinoma
Frozen Sections
Meningioma
Neoplasms
Neoplasm Metastasis
Glioblastoma
Keratins
Brain Neoplasms
Differential Diagnosis
Transcription Factors
Hormones
Brain

Keywords

  • Dural
  • Frozen section
  • Immunohistochemistry
  • Meningioma
  • Metastatic carcinoma
  • Radiology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

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title = "Dural-based metastatic carcinomas mimicking primary CNS neoplasia: Report of 7 cases emphasizing the role of timely surgery and accurate pathologic evaluation",
abstract = "Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas. Following the receipt of HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6 meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records and follow-up data were reviewed. Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and {"}picket-fence{"} like glands were among useful histologic diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases. Subsequent clinical and radiologic evaluation confirmed coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery. Although high-grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic carcinomas.",
keywords = "Dural, Frozen section, Immunohistochemistry, Meningioma, Metastatic carcinoma, Radiology",
author = "Savage, {Natasha Marie} and Alleyne, {Cargill Herley} and Vender, {John R} and {Figueroa Ortiz}, {Ramon E} and Hui Zhang and Samuel, {Thomas A.} and Suash Sharma",
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T1 - Dural-based metastatic carcinomas mimicking primary CNS neoplasia

T2 - Report of 7 cases emphasizing the role of timely surgery and accurate pathologic evaluation

AU - Savage, Natasha Marie

AU - Alleyne, Cargill Herley

AU - Vender, John R

AU - Figueroa Ortiz, Ramon E

AU - Zhang, Hui

AU - Samuel, Thomas A.

AU - Sharma, Suash

PY - 2011/11/2

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N2 - Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas. Following the receipt of HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6 meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records and follow-up data were reviewed. Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and "picket-fence" like glands were among useful histologic diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases. Subsequent clinical and radiologic evaluation confirmed coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery. Although high-grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic carcinomas.

AB - Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas. Following the receipt of HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6 meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records and follow-up data were reviewed. Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and "picket-fence" like glands were among useful histologic diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases. Subsequent clinical and radiologic evaluation confirmed coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery. Although high-grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic carcinomas.

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KW - Frozen section

KW - Immunohistochemistry

KW - Meningioma

KW - Metastatic carcinoma

KW - Radiology

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