A RARE BRAIN METASTASIS

DR AMIT KUMAR GHOSHCONSULTANT NEUROSURGEON

60 YEARS, MALE

Right sided weakness followed by progressive drowsiness over 3 days

Past history of CHONDROSARCOMA in left 7th Rib ----Excision 10 years ago

On September,2014, he had left lower lobe of lung involvement-----Resection of lower lobe with chest wall reconstruction was done.

On examination( at admission),

Haemodynamically stable

Drowsy ( E2M5V2), Pupil—equal and reacting both sides.

Right sided hemiparesis( grade 2)

CLINICAL PROFILE

CT BRAIN

CONTRAST MRI

DSA WAS NORMAL

TREATMENT

• CRANIOTOMY,EVACUATION OF HEMATOMA,EXCISION OF TUMOUR

• POST-OPERATIVE VENTILATION• CRITICAL CARE MANAGEMENT• GRAGUAL RECOVERY• Patient is conscious, obeying commands,

started talking

POST-OPERATIVE CT BRAIN

HISTOPATHOLOGY

• METASTATIC WELL DIFFERENTIATED CHONDROSARCOMA

HISTOPATHOLOGY SHOWING MALIGNANT CARTILAGE

HISTOPATHOLOGY SHOWING MITOTIC ACTIVITY

HISTOPATHOLOGY SHOWING D240 IMMUNOPOSITIVITY

HISTOPATHOLOGY SHOWING HIGH Ki67 proliferative index

HISTOPATHOLOGY SHOWING S100 IMMUNOPOSITIVITY

LITERATURE REVIEW AND DISCUSSIONPrimary intracranial chondro sarcoma constitutes only 0.16% of all intracranial tumors. Primary Intracranial chondrosarcomas are of three variants: Classical, mesenchymal and myxoid. Classical is graded as I, II, III.

Chondrosarcomas commonly arise from the skullbase. Extraskeletal chondrosarcomas of dural origin are rare and only 53 cases have been reported till date.

Primary intraparenchymal chondrosarcoma—only 4 cases reported

Brain Metastasis is exceedingly rare with only 12 reported cases.

Treatment with chemo- and radiotherapy has resultedin poor results

Once BM is diagnosed, it is usually treated with excisional surgery

More recently, GKSRS has shown promise to be aneffective modality with long-term survival and improvementin quality of life.

1) Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A, Sweiss F, Drazin D. Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, andoutcomes.

Sarcoma. 2014;2014:475175.

2) Krishnan SS, Panigrahi M, Varma D, Madigubba S. Falcine and parasagittal intracranial chondrosarcomas of the classical variant: Report of two cases with review of literature. Neurol India 2011;59:451-4

3) Mishra S, Mishra RC, Subbarao KC, Sharma M C. Intraparenchymal mesenchymal chondrosarcoma in an unusual location. Neurol India 2012;60:121-2

LITERATURE REVIEW