Innumerable hemorrhagic brain metastases from a neuroendocrine tumor grade-1 with prolonged natural history. (May 2021)

• Record Type: Journal Article
• Authors: Elarjani, Turki; Alamer, Othman Bin; Dababo, Mohammad; Hassounah, Maher
• Is Part Of: International journal of surgery case reports. Volume 82(2021)
• Publication Date: 2021-05
• Subjects: NET neuroendocrine tumors -- ECOG Eastern cooperative oncology group -- WBRT whole-brain radiation therapy -- CT computed tomography -- MRI magnetic resonance imaging -- TTF-1 thyroid transcription factor-1 -- GFAP glial fibrillary acidic protein -- MANEC mixed adenoneuroendocrine carcinoma -- SWI susceptibility weighted imaging; Neuroendocrine tumor -- Low grade -- Brain metastases -- Natural history -- Differential diagnosis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105855
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Neuroendocrine tumor metastasis to the brain is a rare entity that commonly originates from the lungs. Neuroendocrine tumor grade 1, which is considered benign, can metastasize to the brain. Neuroendocrine tumor can mimic other cerebral metastatic diseases in terms of hemorrhagic appearance, and thus, should be considered among the differential diagnosis. Abstract: Background: Neuroendocrine tumors (NET) are rare tumors with a low incidence of brain metastasis, especially in grade 1 NET. The most common source of brain metastasis is the lung. We present an unusual case of NET grade 1 with multiple hemorrhagic brain metastases. Case description: A 46-year-old woman, who initially presented with a seizure, was diagnosed with multiple brain and lung lesions. She was offered a biopsy for diagnosis, but she refused and lost to follow up. Eighteen years later, she developed progressive quadriparesis and confusion. A biopsy of the left frontal lobe lesions showed NET grade 1. A lung biopsy of the left upper lobe was consistent with the same diagnosis. The patient's functional status was poor with Eastern Cooperative Oncology Group (ECOG) grade 4. She only received palliative whole-brain radiation therapy (WBRT) and died 3 months after discharge. Clinical discussion: NET is a spectrum that encompasses benign to malignant cells. There is a female predominance in lower grades and male predominance in higher grades. No effective management for brain metastases was described, and the prognosis remains poor. Conclusion: Multiple brain metastases can be the first presentation of patients with NET. Early diagnosis and treatment may have a more favorable impact on the outcome of this disease. The longstanding numerous hemorrhagic NET brain metastases is exceedingly rare. The neuroimaging appearance is similar to other neoplastic and non-neoplastic lesions. An important differential diagnosis to consider is metastatic melanoma and choriocarcinoma, familial cavernous malformation, diffuse axonal injury, cerebral vasculitis, and amyloid angiopathy.