Case Report

A Rare Case of Brain Metastasis

Amit Kumar Ghosh*, Rafit Deb Barma, TN Sharma and Malay Chakrabarty

Calcutta University, India

Submission: September 19, 2016; Published: September 28, 2016

*Corresponding author: Calcutta University, India, Tel:9830151497; Email:amitghosh74@yahoo.co.in

How to cite this article: Amit K G, Rafit D B, TN Sharma, Malay C.A Rare Case of Brain Metastasis. Open Access J Neurol Neurosurg. 2016; 1(2):555560. DOI: 10.19080/OAJNN.2016.01.555560

Abstract

Intracerebral metastasis from chondrosarcoma is rare. This is a case report of 46 year old man with intracerebral metastasis from rib chondrosarcoma who was operated and literature was reviewed.

Keywords: Chondrosarcoma; Intracerebral metastasis

Introduction

A 46 years old man presented with generalised tonic clonic seizure followed by drowsiness and admitted in the hospital. History revealed that he had developed right sided weakness over the last 2 weeks but ignored. He underwent left 7-9^th rib resection for chondrosarcoma of 8^th rib 13 years ago. No other detailed data regarding the type and grade of the lesion was available. Chest X-ray was done (Figure 1).

On examination, Patient’s GCS was E2V1M5, pupils were equal and reacting to light, there was a paucity of movement in right side. After getting the CT scan of the brain (Figure 2), either hematoma or tumor was suspected. The patient was taken for immediate surgery. Considering the mass effect left sided decompressive craniectomy was done and the lesion was an intracerebral tumor with intratumoral hemorrhage (Figure 3). There was no dural attachment with the lesion. Complete excision of the tumor was done. Post-operative CT scan of brain showed diminution of mass effect (Figure 4). The patient had recovered well. Histopathology revealed metastatic well differentiated chondrosarcoma (Figure 5A, 5B, 5C, 5D, 5E). The patient had been referred to oncology side for subsequent evaluation and management.

Discussion

Chondrosarcoma is a malignancy of mesenchyme that is a common primary bone tumor subsequent to osteosarcoma in frequency. It has been classified based on histological appearance into slow growing, benign and malignant grade I to grade III. Distant metastases account for 10% of grade II and, 71% of grade III, commonly occurring to the lungs, other bones, and liver, resulting in a mere 5-year survival of 18 %. Primary intracranial chondrosarcoma constitutes only 0.16% of all intracranial tumors. Brain metastasis is exceedingly rare. Only 12 cases have been reported [1,2].

Primary intracranial Chondrosarcomas commonly arise from the skull base. Intracranial chondrosarcomas are of three variants: Classical, mesenchymal and myxoid. Classical variant has three histological grades: Grade I, II and III. Extraskeletal chondrosarcomas of dural origin are rare and only 53 cases have been reported till date [3]. Primary intracerebral chondrosarcoma is extremely rare--only 4 cases reported [4].

A strong propensity for local recurrence is observed in mesenchymal chondrosarcomas with a reported rate of ~65%. Though adjuvant radiotherapy is administered, there is no conclusive data regarding its efficacy in preventing recurrence. For skull base Chondrosarcoma, Radiosurgery as an adjuvant therapy after microsurgery is very effective in reducing recurrence. Role of proton beam is restricted to large inoperable tumors [4]. Chemotherapy is usually reserved for metastasis [5].

References

1. Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A (2014) Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes. 2014: 475175.
2. Güneş M, Günaldi O, Tuğcu B, Tanriverdi O, Güler AK, et al. (2009) Intracranial chondrosarcoma: A case report and review of the literature. Minim Invasive Neurosurg 52(5-6): 238-241.
3. Krishnan SS, Panigrahi M, Varma D, Madigubba S (2011) Falcine and parasagittal intracranial chondrosarcomas of the classical variant: Report of two cases with review of literature. Neurol India 59(3): 451- 454.
4. Mishra S, Mishra RC, Subbarao KC, Sharma MC (2012) Intraparenchymal mesenchymal chondrosarcoma in an unusual location. Neurol India 60(1): 121-122.
5. Sheth RN, Thompson SN, Morcos JJ (2009) Drop Metastasis from Primary Intracranial Mesenchymal Chondrosarcoma: Case Report. FRCS Ann Neurosurg 9(7): 1-9.