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Pangratz-Daller C, Grimm J, Pfaff JAR, Kraus TFJ, Sotlar K, Rahman Al-Schameri A, Kral M, Griessenauer CJ, Schwartz C. Meningeal Metastasis Causing Chronic Subdural Hematoma in a Cancer Patient with Bilateral Papilledema and Suspected Cerebral Venous Thrombosis: A Case Report. J Neurol Surg A Cent Eur Neurosurg 2024; 85:105-111. [PMID: 35453161 DOI: 10.1055/a-1832-3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Meningeal metastasis has been reported as a very rare cause of chronic subdural hematoma (CSH). Here, we report a female patient who had undergone initial burr hole drainage of a CSH at an outside hospital. Postoperatively, the patient additionally suffered from visual impairment due to bilateral papilledema and the patient was eventually transferred to our neurosurgical department for additional treatment. A craniotomy was performed and due to intraoperative suspicious findings, histopathologic samples were obtained that revealed a metastasis of thus far undiagnosed triple negative breast cancer. Furthermore, the patient was suspected to have a partial cerebral venous thrombosis (CVT). Our case report addresses this extremely rare clinical constellation. We provide a detailed overview on our patient's clinical and radiologic course, and discuss the potential association of CSH with meningeal metastasis and bilateral papilledema.
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Affiliation(s)
- Cornelia Pangratz-Daller
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jochen Grimm
- Department of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Johannes A R Pfaff
- Department of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Theo F J Kraus
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Abdul Rahman Al-Schameri
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Kral
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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Predictive value of a nomogram for hepatocellular carcinoma with brain metastasis at initial diagnosis: A population-based study. PLoS One 2019; 14:e0209293. [PMID: 30601858 PMCID: PMC6314620 DOI: 10.1371/journal.pone.0209293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
Abstract
Background Population-based estimates of the incidence and prognosis of brain metastases at diagnosis of hepatocellular carcinoma (HCC) are lacking. The aim of this study was to characterize the incidence proportion and survival of newly diagnosed hepatocellular carcinoma with brain metastases (HCCBM). Materials and methods Data from Surveillance, Epidemiology, and End Results (SEER) program between 2010 and 2014 was evaluated. Patients with HCCBM were included. Multivariable logistic and Cox regression were performed to identify predictors of the presence of brain metastases at diagnosis and prognostic factors of overall survival (OS). We also built a nomogram based on Cox model to predict prognosis for HCCBM patients. Results We identified 97 patients with brain metastases at the time of diagnosis of HCC, representing 0.33% of the entire cohort. Logistic regression showed patients with bone or lung metastases had greater odds of having brain metastases at diagnosis. Median OS for HCCBM was 2.40 months. Cox regression revealed unmarried and bone metastases patients suffered significantly shorter survival time. A nomogram was developed with internal validation concordance index of 0.639. Conclusions This study provided population-based estimates of the incidence and prognosis for HCCBM patients. The nomogram could be a convenient individualized predictive tool for prognosis.
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Sartori Balbinot R, Facco Muscope AL, Dal Castel M, Sartori Balbinot S, Angelo Balbinot R, Soldera J. Intraparenchymal Hemorrhage due to Brain Metastasis of Hepatocellular Carcinoma. Case Rep Gastroenterol 2017; 11:516-525. [PMID: 29033772 PMCID: PMC5637007 DOI: 10.1159/000479221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023] Open
Abstract
Although extrahepatic metastases from hepatocellular carcinoma (HCC) are present in only 5–15% of cases, they are certainly factors associated with poor prognosis. The main sites include lung, lymph nodes, bones, and adrenal glands, in descending order. Metastasis in the central nervous system is extremely rare, and the incidences vary from 0.6 to 1.7%. We report a case of a 54-year-old man previously diagnosed with alcohol-induced cirrhosis of the liver and HCC. The patient was admitted presenting progressive left hemiparesis and headache which started 2 days earlier, with no history of cranioencephalic trauma. After admission, cranial computed tomography revealed an intraparenchymal hemorrhage area with surrounding edema in the right frontal lobe. An angioresonance requested showed a large extra-axial mass lesion located in the right frontal region with well-defined contours and predominantly hypointense signal on T2 sequence. At first, the radiological findings suggested meningioma as the first diagnostic hypothesis. However, the patient underwent surgery. The tumor was completely removed, and the morphological and immunohistochemical findings were consistent with metastatic hepatocarcinoma associated with meningioma. In postoperative care, the patient did not recover from the left hemiparesis and manifested Broca's aphasia. He had a survival time of 24 weeks, presenting acute liver failure as his cause of death. There is a lack of evidence supporting a specific management of patients with brain metastasis from HCC. Furthermore, there are no studies that evaluate different modalities of therapeutics in brain metastasis of HCC due to the rarity of this condition. Therefore, management must be individualized depending on probable prognostic factors in these patients.
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Affiliation(s)
| | | | - Mateus Dal Castel
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Silvana Sartori Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Raul Angelo Balbinot
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Clinical Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Jonathan Soldera
- Faculty of Medicine, Universidade de Caxias do Sul, Caxias do Sul, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Kamimura K, Kobayashi Y, Takahashi Y, Abe H, Kumaki D, Yokoo T, Kamimura H, Sakai N, Sakamaki A, Abe S, Takamura M, Kawai H, Yamagiwa S, Terai S. Tumor markers for early diagnosis for brain metastasis of hepatocellular carcinoma: A case series and literature review for effective loco-regional treatment. Cancer Biol Ther 2017; 18:79-84. [PMID: 28045618 DOI: 10.1080/15384047.2016.1276134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Intrahepatic lesions of hepatocellular carcinoma (HCC) have been controlled by significant advances in treatment using loco-regional therapies, including, surgery, ablative therapy, catheter-based chemotherapy, and embolization. Consequently, the number of patients with extrahepatic metastatic lesions has increased. Their prognosis remains poor with approximately <1 y of survival from the time of diagnosis. A molecularly targeted drug, sorafenib, have been used to treat extrahepatic lesions and shown the prolonged survival time. However, the therapeutic benefit for the brain metastasis remains unclear, since it causes intratumor bleeding leading to the severe brain damage. No guidelines for the brain metastasis of HCC have been developed to date due to the shortage of the experiences and evidences. Therefore, the development of standard therapy for brain metastasis following the early diagnosis is essential by accumulating the information of clinical courses and evidences. For this purpose, we reviewed cases of HCC brain metastasis reported to date and analyzed additional 8 cases from our hospital, reviewing 592 advanced HCC cases to estimate the possible metastatic lesions in the brain. With careful review of cases and literature, we suggest that the cases with lung metastasis with increase tendency of tumor markers within recent 3-6 months have higher risks of brain metastasis. Therefore, they should be carefully followed by imaging modalities. In addition, the loco-regional treatment, including surgical resection and radiation therapy should be performed for better prognosis by preventing re-bleeding from the tumors.
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Affiliation(s)
- Kenya Kamimura
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Yuji Kobayashi
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Yoshifumi Takahashi
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Hiroyuki Abe
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Daisuke Kumaki
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Takeshi Yokoo
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Hiroteru Kamimura
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Norihiro Sakai
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Akira Sakamaki
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Satoshi Abe
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Masaaki Takamura
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Hirokazu Kawai
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Satoshi Yamagiwa
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
| | - Shuji Terai
- a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan
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