Central Nervous System Miliary Brain Metastasis Secondary to Breast Cancer: Case Report

Abstract

Miliary metastasis to the central nervous system (CNS) is a rare presentation of metastasis mainly found in primary adenocarcinoma of the lung. Its association with breast cancer is even less frequent. We present the case of a 50-year-old female patient diagnosed in 2010 with stage IIA infiltrating ductal breast cancer RE (-), RP (+), HER 2 (-), HER2 NEU (+). She was treated with modified radical left breast mastectomy, radiation therapy, and chemotherapy. Her condition began presenting oppressive frontal headache without irradiation, predominantly in the evening, intensity 8/10, which decreased when sleeping and was exacerbated with stressful situations, in addition to progressive cognitive deterioration. Simple and contrasted computed tomography (CT) of the skull and thoracoabdominal were requested, showing multiple micronodular lesions with calcium density in the brain parenchyma, left pleural effusion, hypo and hyperdense lesions in the liver parenchyma, as well as osteoblastic lesions in the lumbar spine. Simple and contrasted magnetic resonance imaging (MRI) of the skull showed multiple supra and infratentorial intra-axial lesions. The most frequent associated symptom with miliary metastasis is cognitive impairment. Miliary metastasis, confirmed by imaging studies and histopathology, requires the ruling out of other causes of this calcification pattern, such as neurocysticercosis, due to specific treatment for each pathology.

Imaging findings in carcinomatous encephalitis secondary to malignant melanoma

“…In a recent review, only 26 cases of miliary CNS metastases have been reported and none of these cases were related to melanoma; the most frequent primary tumor was lung (61.54%), followed by breast and unknown origin, with 11.54% each [8].…”

“…The etiology of CE is not fully known [8], but probably the BRAF V600E mutated could play a role in the onset of CE related to melanoma [5]; other research is needed to assess the possible role of this gene in the CE pathogenesis.…”

“…The clinical presentation of miliary brain metastases can vary, but the most frequent symptoms are the cognitive impairment and the subacute dementia. The great variety of symptoms observed is the consequence of the multifocal involvement of cortical and subcortical structures [8,10]. In general, the median interval from initial diagnosis of malignant melanoma and the onset Fig.…”