Abstract

Metastasis of one cancer to another tumor is an unusual pathologic event, with most reported cases involving metastases to intracranial meningio-mas. Among these, breast carcinoma followed by lung carcinoma, were the most common sources. We report a case of a patient with breast carcinoma who developed metastasis to a spinal meningioma. The clinical, radiological, and pathological features of this interesting phenomenon, including light microscopic and immunohistochemical features are delineated. A 79-year-old woman diagnosed with metastatic breast cancer presented with mid-back pain, parapare-sis, hypoesthesia and paresthesia in both lower limbs. She had history of an ischemic cerebrovascular acci-dent and a frontal meningioma. Her breast cancer was diagnosed on June, 2006 and metastasized to bone marrow, skull, right second and third rib and seventh thoracic vertebra. The physical exam was remarkable for patellar and achillar hyperreflexia, but there was no tenderness on palpation of the vertebral spine. Magnetic resonance imaging (MRI) of the whole spine revealed an intradural round lesion located at T4–T5 that was suspected to be a meningioma. The patient underwent T4–T5 laminectomies and the tumor was resected. Pathologic evaluation revealed metastasis of breast carcinoma in a fibrous ⁄psammo-matous meningioma. Immunohistochemistry on metastatic carcinoma and primary tumor was posi-tive for CK34bE12, Estrogen Receptor (ER), 6CDFD-15 (mammoglobin) and epithelial membrane antigen (EMA) and negative for E-cadherin, Progesterone Receptor (PR) and CD56 (NCAM). Meningioma cells were negative for E-cadherin, ER, PR, CK34bE12, CD56, mammoglobin and EMA. She was treated with hormone therapy due to a performance status 3. The patient is currently alive and a brain MRI in January 2008 showed a slight increase in size of the meningi-oma. E-cadherin and NCAM are two cell-adhesion mole-cules that may play a pathogenic role in the tumor-to-tumor phenomenon. However in our case they were expressed neither by the meningioma nor by the breast carcinoma. We believe that it is very important to maintain this unusual combined pathology in the differential diag-nosis of central nervous system lesions. Patients with a known meningioma who develop a malignancy should undergo more frequent imaging, with a lower thresh-old for resection and thorough histopathological examination looking for malignancy. Acknowledgment We want to express our appreciation to Dr. Arkadiusz Dudek and Dr. Robert Kratzke for reviewing the manuscript.