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An extremely rare, remote intracerebral metastasis of oral cavity cancer: a case report.

Leimert M, Juratli TA, Lindner C, Geiger KD, Gerber J, Schackert G, Kirsch M - Case Rep Med (2013)

Bottom Line: MR imaging revealed an enhancing lesion in the right parietal lobe.The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence.To the authors' knowledge, only two similar cases have been previously reported.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.

ABSTRACT
Distant brain metastases from oral squamous cell carcinomas (OSCC) are extremely rare. Here we describe a case of a 53-year-old man with a primary OSCC who referred to the neurosurgical department because of epileptic seizures. MR imaging revealed an enhancing lesion in the right parietal lobe. A craniotomy with tumor removing was performed. Histopathological examination verified an invasive, minimally differentiated metastasis of the primary OSCC. The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence. To the authors' knowledge, only two similar cases have been previously reported.

No MeSH data available.


Related in: MedlinePlus

Histology and immunohistochemistry of OSCC, 5 μm thick serial sections of both primary tumor and cerebral metastasis were stained with H&E. Immunochemistry was performed using an indirect peroxidase system with nonbiotinylated polymer secondary antibodies following the instructions of the manufacturer (MEDAC). Diaminobenzidine (Sigma, brown) is used as a chromogen. Magnification: original × 20. (a) Primary intermediately differentiated squamous cell carcinoma of the oral cavity with recognizable squamous cell differentiation. (b) Cerebral metastasis of poorly differentiated squamous cell carcinoma containing few horn pearls (arrow heads) and central necrosis. (c) Cerebral metastasis of OSCC, immunocytochemistry for CK 5/6, a cytokeratin marker indicative for squamous cell carcinoma with completely positive brown reaction product on the plasma membrane of nearly all tumor cells. Adjacent brain tissue shows gliosis but remains negative for CK-5/6 (light blue). (d) Cerebral metastasis of OSCC, immunohistochemistry for EGFR shows strong overexpression with complete staining of the cell membranes in all vital tumor cells. Note the negative results in remaining brain parenchyma (light blue).
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fig3: Histology and immunohistochemistry of OSCC, 5 μm thick serial sections of both primary tumor and cerebral metastasis were stained with H&E. Immunochemistry was performed using an indirect peroxidase system with nonbiotinylated polymer secondary antibodies following the instructions of the manufacturer (MEDAC). Diaminobenzidine (Sigma, brown) is used as a chromogen. Magnification: original × 20. (a) Primary intermediately differentiated squamous cell carcinoma of the oral cavity with recognizable squamous cell differentiation. (b) Cerebral metastasis of poorly differentiated squamous cell carcinoma containing few horn pearls (arrow heads) and central necrosis. (c) Cerebral metastasis of OSCC, immunocytochemistry for CK 5/6, a cytokeratin marker indicative for squamous cell carcinoma with completely positive brown reaction product on the plasma membrane of nearly all tumor cells. Adjacent brain tissue shows gliosis but remains negative for CK-5/6 (light blue). (d) Cerebral metastasis of OSCC, immunohistochemistry for EGFR shows strong overexpression with complete staining of the cell membranes in all vital tumor cells. Note the negative results in remaining brain parenchyma (light blue).

Mentions: After biopsy, a radical surgical resection of the tumor with supraomohyoid and functional neck dissection in continuity and reconstruction with a radial forearm free flap was performed. Histopathological work-up diagnosed a primary oral squamous cell carcinoma stage T3N3 (Figure 3(a)). Based on the stage of this diagnosis, adjuvant radiotherapy was initiated with a total dose of 64 Gy delivered in 32 fractions to both sides of the neck and the primary site. A CT scan revealed bilateral small pulmonary nodules, which were diagnosed as pulmonary metastases, but the patient declined chemotherapy. After radiation therapy, he was well and with stable disease for 26 months. Then, after a 3-week period of general weakness, he developed epileptic seizures which initiated further diagnostic work-up.


An extremely rare, remote intracerebral metastasis of oral cavity cancer: a case report.

Leimert M, Juratli TA, Lindner C, Geiger KD, Gerber J, Schackert G, Kirsch M - Case Rep Med (2013)

Histology and immunohistochemistry of OSCC, 5 μm thick serial sections of both primary tumor and cerebral metastasis were stained with H&E. Immunochemistry was performed using an indirect peroxidase system with nonbiotinylated polymer secondary antibodies following the instructions of the manufacturer (MEDAC). Diaminobenzidine (Sigma, brown) is used as a chromogen. Magnification: original × 20. (a) Primary intermediately differentiated squamous cell carcinoma of the oral cavity with recognizable squamous cell differentiation. (b) Cerebral metastasis of poorly differentiated squamous cell carcinoma containing few horn pearls (arrow heads) and central necrosis. (c) Cerebral metastasis of OSCC, immunocytochemistry for CK 5/6, a cytokeratin marker indicative for squamous cell carcinoma with completely positive brown reaction product on the plasma membrane of nearly all tumor cells. Adjacent brain tissue shows gliosis but remains negative for CK-5/6 (light blue). (d) Cerebral metastasis of OSCC, immunohistochemistry for EGFR shows strong overexpression with complete staining of the cell membranes in all vital tumor cells. Note the negative results in remaining brain parenchyma (light blue).
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fig3: Histology and immunohistochemistry of OSCC, 5 μm thick serial sections of both primary tumor and cerebral metastasis were stained with H&E. Immunochemistry was performed using an indirect peroxidase system with nonbiotinylated polymer secondary antibodies following the instructions of the manufacturer (MEDAC). Diaminobenzidine (Sigma, brown) is used as a chromogen. Magnification: original × 20. (a) Primary intermediately differentiated squamous cell carcinoma of the oral cavity with recognizable squamous cell differentiation. (b) Cerebral metastasis of poorly differentiated squamous cell carcinoma containing few horn pearls (arrow heads) and central necrosis. (c) Cerebral metastasis of OSCC, immunocytochemistry for CK 5/6, a cytokeratin marker indicative for squamous cell carcinoma with completely positive brown reaction product on the plasma membrane of nearly all tumor cells. Adjacent brain tissue shows gliosis but remains negative for CK-5/6 (light blue). (d) Cerebral metastasis of OSCC, immunohistochemistry for EGFR shows strong overexpression with complete staining of the cell membranes in all vital tumor cells. Note the negative results in remaining brain parenchyma (light blue).
Mentions: After biopsy, a radical surgical resection of the tumor with supraomohyoid and functional neck dissection in continuity and reconstruction with a radial forearm free flap was performed. Histopathological work-up diagnosed a primary oral squamous cell carcinoma stage T3N3 (Figure 3(a)). Based on the stage of this diagnosis, adjuvant radiotherapy was initiated with a total dose of 64 Gy delivered in 32 fractions to both sides of the neck and the primary site. A CT scan revealed bilateral small pulmonary nodules, which were diagnosed as pulmonary metastases, but the patient declined chemotherapy. After radiation therapy, he was well and with stable disease for 26 months. Then, after a 3-week period of general weakness, he developed epileptic seizures which initiated further diagnostic work-up.

Bottom Line: MR imaging revealed an enhancing lesion in the right parietal lobe.The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence.To the authors' knowledge, only two similar cases have been previously reported.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.

ABSTRACT
Distant brain metastases from oral squamous cell carcinomas (OSCC) are extremely rare. Here we describe a case of a 53-year-old man with a primary OSCC who referred to the neurosurgical department because of epileptic seizures. MR imaging revealed an enhancing lesion in the right parietal lobe. A craniotomy with tumor removing was performed. Histopathological examination verified an invasive, minimally differentiated metastasis of the primary OSCC. The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence. To the authors' knowledge, only two similar cases have been previously reported.

No MeSH data available.


Related in: MedlinePlus