gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Evidence of local invasion in breast and lung cancer brain metastases

Meeting Abstract

  • Laila Siam - Abteilung für Neurochirurgie, Georg August Universität Göttingen, Germany
  • Tobias Pukrop - Abteilung für Hämatologie und Onkologie, Georg August Universität Göttingen, Germany
  • Alf Giese - Abteilung für Neurochirurgie, Georg August Universität Göttingen, Germany
  • Chrsitine Stadelmann - Abteilung für Neuropathologie, Georg August Universität Göttingen, Germany
  • Veit Rohde - Abteilung für Neurochirurgie, Georg August Universität Göttingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1747

DOI: 10.3205/10dgnc218, URN: urn:nbn:de:0183-10dgnc2187

Published: September 16, 2010

© 2010 Siam et al.
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Outline

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Objective: Recently Baumert and colleges evaluated brain metastases for the existence of an infiltration zone in 45 autopsies (Baumert et al., 2006). The chief origin of the metastases was lung cancer (>50%), followed by 5 cases of melanoma and breast cancer. 78 metastases were investigated and 63% showed an infiltration zone with cancer cells invading the adjacent brain tissue. In some samples they detected cancer cells in the benign tissue one mm beyond the microscopic edge of the solid tumor. In our retrospective study, we investigated 15 brain metastases of breast cancer and 8 metastases of non small cell lung cancer (NSCLC) patients for carcinoma cell infiltration into adjacent brain tissue.

Methods: Tumor tissue for immunohistochemistry (IHC) was obtained from 23 neurosurgically resected brain metastases with approval of the local ethics committee. The formalin-fixed and paraffin-embedded tissues were HE stained and IHC was performed with anti-pan-cytokeratin and anti-E-Cadherin. The brain metastases interface was demonstrated by anti-GFAP IHC. First the tissues were analyzed for the presence of adjacent brain tissue then the brain tissues were investigated for invading carcinoma cells. Scoring was regareded as being positive for carcinoma infiltration by the existence of more than one cytokeratin or E-Cadherin positive cell in the brain tissue.

Results: In 13/15 samples of breast cancer brain metastases, adjacent tissue was present and in 11 metastases, cancer cells infiltrated adjacent brain tissue. 4/8 NSCLC samples could be evaluated. In 2 samples carcinoma cells had invaded into the adjacent brain. Altogether we detected an infiltration zone in 56% of the carcinoma metastasis.

Conclusions: In comparison to the recent autopsy study, we demonstrate the existence of an infiltration zone in more than 50% of lung and breast cancer brain metastases, at the time of surgical resection already. Considering that six metastases could not be evaluated due to the lack of adjacent brain within the specimen, this figure may even be underestimating the degree of microscopic dissemination. Along these lines, a Korean study showed less local recurrence after microscopic total resection followed by radiotherapy compared to control group (Yoo et al., 2009). This study also underlines the existence of an active cancer cell infiltration which may require a reconsideration of current resection techniques for at least some types of brain metastases.