Онкология METASTASES IN BRAIN AND IN BASE OF THE SKULL В OF CARCINOMAS, SELDOM METASTASIZING IN CNS (clinical-morphological analysis of 51 observations and literature review)
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ONCOLOGY BULLETIN OF THE VOLGA REGION

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METASTASES IN BRAIN AND IN BASE OF THE SKULL В OF CARCINOMAS, SELDOM METASTASIZING IN CNS (clinical-morphological analysis of 51 observations and literature review)

D.L. Rotin, M.A. Stepanian, V.A. Cherekaev

Abstract. Diagnosis «metastasis from unknown primary source (UPS)» occurs in 3—10% of oncological patients. Some patients with UPS develop brain metastases (BM). BM from UPS account up to 15% cases of all BMs. Group of patients often follows BM of lung and breast cancer, taking the third place. Median of age does not differ significantly with other BMs (5th—6th decades). Fossa posterior is more frequent affected in BM from UPS. The presence of extracerebral metastases is the factor of poor prognosis. As a rule, all cases of long survival are associated with effective treatment of BM in the absence of extracerebral metastases. Lung carcinoma is the most frequent primary in patients with BM from UPS. The aim of examination is the identification of the patients with good prognostic features and perspective for further specific treatment. Full clinical and laboratory examination together with the instrumental minimum has to follow MRI with contrast enhancement. Routine application of PET remains undefined. Single BM requires differential diagnosis with CNS primary neoplastic and tumor-like lesions. In contrast, the complex of resources directed onto the primary source definition has to be limited. Neurosurgery in BM from UPS plays not only curative but also diagnostic role, obtaining material for morphological evaluation which provides information for further management and treatment. Light microscopy is usually enough for supporting the diagnosis and preliminary classification of the tumor. Additional techniques, most of all, immunohistochemistry, help to determine the primary source and to avoid odd manipulations. Currently there is not universal algorithm for the management of patients with BM from UPS after neurosurgery. Clinical and morphological heterogeneity gives no reason to summarize and generalize the management strategy and prognosis. Molecular biology of tumor in BM from UPS is wide field for the future investigations.

Key words: brain metastases, the forecast of treatment.

 





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