Clinical characteristics of CNS metastases from primary gynecologic cancers

Abstract

HighlightsMost common symptoms for patients with CNS metastases are headaches and ataxia.Multiple foci are more common than solitary lesions on initial brain imaging.The frontal lobe is most likely to be involved.GTN is diagnosed at a younger age when compared to other gynecologic cancers.More aggressive histologic subtypes confer an increased risk of CNS metastasis.

Endometrial adenocarcinoma presenting as a suprasellar mass: lessons to be learned

“…Atypical sites of metastasis include extra-abdominal lymph nodes, liver, adrenals, brain, bones and soft tissue [6]. Central nervous system (CNS) metastases are generally rare, but in a recent series from University of North Carolina from 2004-2018, 24 cases were identified and 83% of these including 'high grade' (i.e., type 2 histologies) [7]. A preceding Mayo Clinic review of 1,632 endometrial cancer included 18 referred for treatment of brain metastases -those with single site of disease had best prognosis [8].…”

Brain Metastases from Uterine Cervical and Endometrial Cancer

“…Since 1970, 83 papers on the brain parenchymal metastases of CC have been published, including a total of 716 patients ( Table 1 and Table S1 ). In contrast, there are less than 30 cases of leptomeningeal involvement reported in the English literature [ 36 , 81 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 ]. Autopsy studies have reported brain parenchymal metastases in 3–10% of CC patients [ 27 , 57 , 147 ], whereas the estimated frequency in the clinical setting ranged from 0.1% to 2.2% in this review; therefore, we mainly summarized information on brain parenchymal metastases.…”

“…The initial symptoms of BMs from CC may be nonspecific, and may include headaches (45.6%), syncope or seizures (14.0%), ataxia (11.8%), nausea/vomiting (11.0%), hemiparesis (10.3%), visual disturbance including diplopia (8.8%), generalized or extremity weakness (8.8%), altered mental status (6.6%), dizziness (5.1%), confusion (5.1%), speech impairment (5.1%), paresthesia, facial twitching, tinnitus, tremor and hemiballismus [ 11 , 14 , 18 , 20 , 21 , 23 , 24 , 25 , 26 , 28 , 29 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 42 , 43 , 44 , 45 , 47 , 50 , 51 , 52 , 55 , 56 , 57 , 58 , 60 , 61 , 63 , 64 , 65 , 76 , 80 , 81 ]. Intracranial edema resulted in papilledema due to the increased intracranial pressure, which is a common sign of a brain tumor [ 64 , 148 ].…”

“…Most of the BMs were located in the supratentorial region (cerebrum) in 121/165 (73.3%) patients, whereas the infratentorial region (cerebellum) was affected in 44/165 (26.7%) patients. Among the 79 patients for whom details of the supratentorial lesions were known, BMs were located in the parietal, frontal, occipital, and temporal lobes in 27 (34.2%), 21 (26.6%), 16 (20.3%), and 15 patients (19.0%), respectively [ 11 , 14 , 16 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 42 , 43 , 44 , 45 , 47 , 50 , 51 , 52 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 65 , 72 , 73 , 74 , 75 , 76 , 80 , 81 ]. The cerebellum, which occupies only 12.6% of total brain volume, contained a disproportionately high number of BMs for its size.…”

“…The rate of occurrence of BMs located in the parietal lobes is higher than that of BMs from other primary tumors [ 151 ]. Furthermore, when compared to other primaries, patients with CC were found to have a significantly higher percentage of leptomeningeal involvement [ 81 ].…”