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| '''Intracerebral metastasis''' accounts for approximately 25-50% of intracranial tumors in hospitalized patients. The true incidence of brain metastasis is unknown, but recent estimates are as high as 200,000 cases per year in the United States alone. 80% of brain metastases can be accounted for by five primary tumor sites: lung, breast, skin (melanoma), kidney and the gastrointestinal tract. A population-based study of 169,444 cancer patients from 1973 to 2001 in Detroit revealed that overall, 10% of patients diagnosed with one of these five primaries went on to develop brain metastases. Specifically, 19.9% of lung cancers, 6.9% of melanomas, 6.5% of renal cancers, 5.1% of breast cancers and 1.8% of colorectal cancers metastasized to the brain.
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| Parenchymal blood flow is an important determinant of the distribution of metastases. 80% of metastases localize to the cerebral hemispheres, 15% localize to the cerebellum and 3% localize to the basal ganglia. Often these tumors can be found at the gray/white matter junction.
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| ==Gross appearance==
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| 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.
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| ==Microappearance==
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| Typically well-demarcated with the exception of melanoma metastases.
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| ==Radiographic findings==
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| There is a great deal of variability in the appearance of these tumors, however some generalizations can be made.
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| ===CT===
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| '''NECT:''' Iso to hypodense mass with anywhere from zero to marked peritumoral edema.
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| '''CECT:''' enhancement is also variable and can be intense, punctuate, nodular or ring-enhanced if the tumor has out grown it's blood supply.
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| ==Clinical presentation and prognosis==
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| These patients commonly present with headache, seizure, mental status changes, ataxia, nausea and vomiting and visual disturbances. However, 10% of these patients may be asymptomatic.
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| Patients with brain mets have a mean survival of one month without treatment. With treatment, survival improves, but it is still dismal. The mean age of survival is still less than one year.
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| ==References==
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| * Eichler AF, Loeffler JS. Multidisciplinary Management of Brain Metastases. The Oncologist 2007;12:884-898.
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| * Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier Saunders. 2005.
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| * Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan Detroit cancer surveillance system. J of Clin Oncol 2004;22(14):2865-72.
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| ==Source==
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| [http://www.radiopaedia.org Radiopaedia]
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| [[Category:Oncology]] | | [[Category:Oncology]] |
| | [[Category:Disease]] |
| | [[Category:Neurology]] |
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