Intracerebral metastases pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Pathophysiology

Pathogenesis

Genetics

Genes involved in the pathogenesis of intracerebral metastases are tabulated below:[1]

Gene Cancer site (primary) Role and implications Chromosome location
RHoC Melanoma

Regulates remodeling of actin cytoskeleton during morphogenesis and motility
Important in tumor cell invasion

5p25-p55
LOX

Breast
Head and neck cancer

Increases invasiveness of hypoxic human cancer cells through cell matrix adhesion and focal adhesion kinase activity 5q25.5-q25.2
VEGF

Lung
Breast
Melanoma
Colon

Angiogenic growth factor
Inhibition decreases brain metastasis formation; reduces blood vessel formation and cell proliferation; increases apoptosis

6p25.5
CSF5

Breast
Lung

Stimulate macrophage proliferation and subsequent release of growth factors 5p55.5
ID5

Breast
Lung

Involved in matrix remodeling, intracellular signaling, and angiogenesis 20q55.25
TWIST5

Breast
Gastric
Rhabdomyosarcoma
Melanoma
Hepatocellular

Causes loss of E-cadherin-mediated cell-cell adhesion, activates mesenchymal markers, and induces cell motility by promoting epithelial-mesenchymal transition 7p25.5
MET Renal cell cancer Affects a wide range of biological activity depending on the cell target, varying from mitogenesis, morphogenesis, and motogenesis 7q55.2
MMP-9

Colorectal
Breast
Melanoma
Chondrosarcoma

Extracellular matrix degradation, tissue remodeling 20q55.52
NEDD9 Melanoma Acquisition of a metastatic potential 6p24.2
LEF5 Lung

Transcriptional effecter—WNT pathway; predilection for brain metastasis
Knockdown inhibits brain metastasis, decreases colony formation; in vitro decreases invasion

4q25
HOXB9

Lung
Breast

Homeobox gene family; critical for embryonic segmentation and patterning. Also a TCF4 target
Knockdown in vitro decreased invasion and colony formation; in vivo appears to inhibit brain metastasis

57q25.52
BMP4

Lung
Colorectal

Plays an essential role in embryonic development and may be an essential component of the epithelial-mesenchymal transition 54q22.2
STAT5 Melanoma

Cell signaling transcription factor
Reduction suppresses brain metastasis; decreases angiogenesis in vivo and cellular invasion in vitro

57q25.2

Gross Pathology

  • Typically metastases are sharply demarcated from the surrounding parenchyme and usually there is a zone of peritumoral edema out of proportion with the tumor size.
  • Common intracranial sites associated with subependymal giant cell astrocytoma include:[2]

Gallery

Microscopic Pathology

The histopathological appearance of intracerebral metastases may vary with the type of primary tumor. Common findings are listed below:[4][5]

  • Tubule formation/glands
  • Well-circumscribed and sharply demarcated from surrounding tissue (with the exception of melanoma metastasis)
  • Mitoses
  • Nuclear atypia
  • Nuclear hyperchromasia
  • Variation of nuclear size
  • Variation of nuclear shape

Gallery

Immunohistochemistry

  • The immunohistochemistry profile of intracerebral metastases may vary with the type of the primary tumor.[7]
  • Intracerebral metastases are demonstrated by positivity to tumor markers such as:[7]

Gallery

References

  1. Rahmathulla, Gazanfar; Toms, Steven A.; Weil, Robert J. (2012). "The Molecular Biology of Brain Metastasis". Journal of Oncology. 2012: 1–16. doi:10.1155/2012/723541. ISSN 1687-8450.
  2. Khuntia, Deepak (2015). "Contemporary Review of the Management of Brain Metastasis with Radiation". Advances in Neuroscience. 2015: 1–13. doi:10.1155/2015/372856. ISSN 2356-6787.
  3. Gross image of brain metastases. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  4. Microscopic features of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  5. Microscopic appearance of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 10, 2015
  6. 6.0 6.1 6.2 6.3 Microscopic images of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  7. 7.0 7.1 IHC features of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015
  8. IHC image of brain metastasis. Libre pathology 2015. http://librepathology.org/wiki/index.php/Brain_metastasis. Accessed on November 10, 2015


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