Intracerebral metastases pathophysiology

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Differentiating Intracerebral Metastases from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Pathophysiology

Pathogenesis

Genetics

Genes involved in the pathogenesis of intracerebral metastases are tabulated below:[1]

Genes Cancer site (primary) Role and implications Chromosome location
RHoC Melanoma Regulates remodeling of actin cytoskeleton during morphogenesis and motility

Important in tumor cell invasion

1p21-p13
LOX Breast

Head and neck cancer

Increases invasiveness of hypoxic human cancer cells through cell matrix adhesion and focal adhesion kinase activity 5q23.1-q23.2
VEGF Lung

Breast Melanoma Colon

Angiogenic growth factor

Inhibition decreases brain metastasis formation; reduces blood vessel formation and cell proliferation; increases apoptosis

6p21.1
CSF1 Breast

Lung

Stimulate macrophage proliferation and subsequent release of growth factors 1p13.3
ID1 Breast

Lung

Involved in matrix remodeling, intracellular signaling, and angiogenesis 20q11.21
TWIST1 Breast

Gastric Rhabdomyosarcoma Melanoma Hepatocellular

Causes loss of E-cadherin-mediated cell-cell adhesion, activates mesenchymal markers, and induces cell motility by promoting epithelial-mesenchymal transition 7p21.1
MET Renal cell cancer Affects a wide range of biological activity depending on the cell target, varying from mitogenesis, morphogenesis, and motogenesis 7q31.2
MMP-9 Colorectal

Breast Melanoma Chondrosarcoma

Extracellular matrix degradation, tissue remodeling 20q13.12
NEDD9 Melanoma Acquisition of a metastatic potential 6p24.2
LEF1 Lung Transcriptional effecter—WNT pathway; predilection for brain metastasis

Knockdown inhibits brain metastasis, decreases colony formation; in vitro decreases invasion

4q25
HOXB9 Lung

Breast

Homeobox gene family; critical for embryonic segmentation and patterning. Also a TCF4 target

Knockdown in vitro decreased invasion and colony formation; in vivo appears to inhibit brain metastasis

17q21.32
BMP4 Lung

Colorectal

Plays an essential role in embryonic development and may be an essential component of the epithelial-mesenchymal transition 14q22.2
STAT3 Melanoma Cell signaling transcription factor

Reduction suppresses brain metastasis; decreases angiogenesis in vivo and cellular invasion in vitro

17q21.2

Gross Pathology

  • Typically metastases are sharply demarcated from the surrounding parenchyme and usually there is a zone of peritumoral edema out of proportion with the tumor size.
  • Common intracranial sites associated with subependymal giant cell astrocytoma include:[2]

Gallery

Microscopic Pathology

The histopathological appearance of intracerebral metastases may vary with the type of primary tumor. Common findings are listed below:[4][5]

  • Tubule formation/glands
  • Well-circumscribed and sharply demarcated from surrounding tissue (with the exception of melanoma metastasis)
  • Mitoses
  • Nuclear atypia
  • Nuclear hyperchromasia
  • Variation of nuclear size
  • Variation of nuclear shape

Gallery

Immunohistochemistry

  • The immunohistochemistry profile of intracerebral metastases may vary with the type of the primary tumor.[7]
  • Intracerebral metastases are demonstrated by positivity to tumor markers such as:[7]

Gallery

References

  1. Rahmathulla, Gazanfar; Toms, Steven A.; Weil, Robert J. (2012). "The Molecular Biology of Brain Metastasis". Journal of Oncology. 2012: 1–16. doi:10.1155/2012/723541. ISSN 1687-8450.
  2. Khuntia, Deepak (2015). "Contemporary Review of the Management of Brain Metastasis with Radiation". Advances in Neuroscience. 2015: 1–13. doi:10.1155/2015/372856. ISSN 2356-6787.
  3. Gross image of brain metastases. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  4. Microscopic features of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  5. Microscopic appearance of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 10, 2015
  6. 6.0 6.1 6.2 6.3 Microscopic images of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  7. 7.0 7.1 IHC features of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  8. IHC image of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015


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