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A RARE BRAIN METASTASIS
DR AMIT KUMAR GHOSHCONSULTANT NEUROSURGEON
60 YEARS, MALE
Right sided weakness followed by progressive drowsiness over 3 days
Past history of CHONDROSARCOMA in left 7th Rib ----Excision 10 years ago
On September,2014, he had left lower lobe of lung involvement-----Resection of lower lobe with chest wall reconstruction was done.
On examination( at admission),
Haemodynamically stable
Drowsy ( E2M5V2), Pupil—equal and reacting both sides.
Right sided hemiparesis( grade 2)
CLINICAL PROFILE
CT BRAIN
CONTRAST MRI
DSA WAS NORMAL
TREATMENT
• CRANIOTOMY,EVACUATION OF HEMATOMA,EXCISION OF TUMOUR
• POST-OPERATIVE VENTILATION• CRITICAL CARE MANAGEMENT• GRAGUAL RECOVERY• Patient is conscious, obeying commands,
started talking
POST-OPERATIVE CT BRAIN
HISTOPATHOLOGY
• METASTATIC WELL DIFFERENTIATED CHONDROSARCOMA
HISTOPATHOLOGY SHOWING MALIGNANT CARTILAGE
HISTOPATHOLOGY SHOWING MITOTIC ACTIVITY
HISTOPATHOLOGY SHOWING D240 IMMUNOPOSITIVITY
HISTOPATHOLOGY SHOWING HIGH Ki67 proliferative index
HISTOPATHOLOGY SHOWING S100 IMMUNOPOSITIVITY
LITERATURE REVIEW AND DISCUSSIONPrimary intracranial chondro sarcoma constitutes only 0.16% of all intracranial tumors. Primary Intracranial chondrosarcomas are of three variants: Classical, mesenchymal and myxoid. Classical is graded as I, II, III.
Chondrosarcomas commonly arise from the skullbase. Extraskeletal chondrosarcomas of dural origin are rare and only 53 cases have been reported till date.
Primary intraparenchymal chondrosarcoma—only 4 cases reported
Brain Metastasis is exceedingly rare with only 12 reported cases.
Treatment with chemo- and radiotherapy has resultedin poor results
Once BM is diagnosed, it is usually treated with excisional surgery
More recently, GKSRS has shown promise to be aneffective modality with long-term survival and improvementin quality of life.
1) Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A, Sweiss F, Drazin D. Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, andoutcomes.
Sarcoma. 2014;2014:475175.
2) Krishnan SS, Panigrahi M, Varma D, Madigubba S. Falcine and parasagittal intracranial chondrosarcomas of the classical variant: Report of two cases with review of literature. Neurol India 2011;59:451-4
3) Mishra S, Mishra RC, Subbarao KC, Sharma M C. Intraparenchymal mesenchymal chondrosarcoma in an unusual location. Neurol India 2012;60:121-2
LITERATURE REVIEW
