12 patients (21 %) presented unique parenchymal metastases and 13 patients (22 %) only intracranial metastases.
We noticed a slight female predominance (30 females – 52 % versus 28 men – 48 %).
The primary neoplasms proved to be: pulmonary (40 %),
breast (21 %),
digestive (14 %),
genital (5 %),
melanoma (3 %),
neuroendocrine (3 %),
urothelial (3 %),
bone (2 %) and unknown in 9 %.
The most common primary cancers responsible for intracranial metastases are lung,
breast and melanoma,
but 10 % remain of unknown origin [3].
Leptomeningeal metastases are usually related to brain tumors,
but the most common extracranial primary tumors responsible for their appearance are breast and small cell lung carcinoma [4].
In our case they were found in patients with breast (4 cases),
ovarian cancer (1) and pulmonary adenocarcinoma (1),
while one remained with an unknown primary neoplasm.
Dural metastases are even rarer,
usually associated to bone secondary lesions [1] (Fig.
6).
Orbital metastases are known to be caused by breast and lung neoplasms [5].
Our case was of a 48 year-old woman who associated orbital,
pituitary and leptomeningeal metastases from breast cancer (Fig.
7).
Her case was a severe one,
discovered at the stage of multiple systemic metastases (in the lungs,
liver,
bone,
lymph nodes,
uterus,
medulla and intracranial).
Pituitary gland metastases are usually located in the posterior lobe,
with breast and lung once again as common primary neoplasms.
[4] Their primary symptom and best indicator of a malignant lesion versus a pituitary adenoma is diabetes insipidus [8],
which our patient didn't present.
Metastases of the lateral ventricle choroid plexus are known to be solitary,
associated to multiple secondary brain lesions.
The usual primary malignancies are renal cell carcinoma and lung cancer [4],
as in our case (Fig.
8).
Paranasal sinus metastases have been reported of kidney,
lung,
breast,
thyroid and prostate origin [9] (Fig.
9).
We also mention 2 cases: that of a 58 year-old woman with bilateral breast cancer (Fig.
10) and a 67 year-old male with urothelial carcinoma,
both with systemic metastases. They presented countless supra- and infratentorial nodulary lesions (in the cerebral and cerebellar hemispheres,
basal ganglia and brain stem),
of miliary pattern,
with a strong enhancement on the CT scan and sizes of less and more than 1 cm diameter.
These characteristics are different from the typical carcinomatous encephalitis,
which presents as uncountable punctate lesions,
visible on the MRI post-contrast examination [10].