Simultaneous Intratumoral Hemorrhage in Multiple Brain Metastases of Endometrioid Carcinoma: A Rare Presentation of A Rare Metastasis

Year 2023, , 302 - 305, 30.12.2023

Sinan Bahadır

https://doi.org/10.18678/dtfd.1339016

Abstract

Metastasis of endometrioid carcinomas to the brain is rare, usually solitary, and has a poor prognosis. Intratumoral bleeding is also a poor prognostic factor for metastatic brain tumors but rarely occurs in gynecological cancers. A female patient who was under chemotherapy for endometrioid carcinoma was admitted to the emergency department for recent deterioration and seizures. She had confusion and left hemiparesis, along with an elevated systolic blood pressure and platelet count of 45,000 /mL. An emergent computerized tomography and subsequent magnetic resonance imaging revealed multiple hemorrhagic metastatic lesions in both hemispheres and cerebellum. Brain metastasis of endometrioid carcinoma is rare and can present with intratumoral hemorrhage, which is associated with a poor prognosis and is more likely to occur in the setting of low platelet counts. This case highlights the importance of monitoring brain metastasis in patients with endometrioid carcinoma and considering the possibility of intratumoral hemorrhage.

Keywords

endometrioid carcinoma, brain metastasis, hemorrhage, thrombocytopenia

Endometrioid Karsinomanın Çoklu Beyin Metastazında Eşzamanlı Tümöriçi Kanama: Nadir Bir Metastazın Nadir Bir Bulgusu

Abstract

Endometrioid karsinomanın beyin metastazı nadir, genellikle tekil ve kötü prognozludur. Tümör içi kanama da metastatik beyin tümörleri için kötü prognoz faktörü olmakla birlikte jinekolojik kanserlerde nadiren gerçekleşir. Endometrioid karsinoma nedeniyle kemoterapi tedavisi devam etmekte olan bir kadın hasta, bilinçte kötüleşme ve nöbet nedeniyle acil servise getirildi. Konfüzyon ve sol hemiparezi mevcut idi. Sistolik kan basıncı yüksek, trombosit sayısı ise 45.000 /mL idi. Acil bilgisayarlı tomografi ve takiben çekilen manyetik rezonans görüntülemede her iki hemisferde ve serebellumda multipl hemorajik metastatik lezyon saptandı. Endometrioid karsinomanın beyin metastazı nadirdir ve tümör içine kanama ile prezente olabilir -ki kötü prognozla ilişkilidir ve daha çok düşük trombosit sayısı durumunda ortaya çıkabilir. Bu vaka endometrioid karsinomalı hastaların beyin metastazı açısından takip edilmesinin ve böyle durumlarda tümör içi kanama olasılığının göz önüne alınmasının önemini vurgulamaktadır.

Keywords

endometrioid karsinoma, beyin metastazları, hemoraji, trombositopeni

References

• McConechy MK, Ding J, Senz J, Yang W, Melnyk N, Tone AA, et al. Ovarian and endometrial endometrioid carcinomas have distinct CTNNB1 and PTEN mutation profiles. Mod Pathol. 2014;27(1):128-34.
• Piura E, Piura B. Brain metastases from endometrial carcinoma. ISRN Oncol. 2012;2012:581749.
• Bhambhvani HP, Zhou O, Cattle C, Taiwo R, Diver E, Hayden Gephart M. Brain metastases from endometrial cancer: clinical characteristics, outcomes, and review of the literature. World Neurosurg. 2021;147:e32-9.
• Moroney MR, Wheeler LJ, Corr BR. Clinical presentation of brain metastases from endometrial carcinoma: A case series. Gynecol Oncol Rep. 2019;28:79-83.
• Pakneshan S, Safarpour D, Tavassoli F, Jabbari B. Brain metastasis from ovarian cancer: a systematic review. J Neurooncol. 2014;119(1):1-6.
• Gardner AB, Charo LM, Mann AK, Kapp DS, Eskander RN, Chan JK. Ovarian, uterine, and cervical cancer patients with distant metastases at diagnosis: most common locations and outcomes. Clin Exp Metastasis. 2020;37(1):107-13.
• Zhang Y, Grant MS, Stepp WH, Clark LH. Clinical characteristics of CNS metastases from primary gynecologic cancers. Gynecol Oncol Rep. 2019;30:100518.
• Karpathiou G, Camy F, Chauleur C, Dridi M, Dal Col P, Peoc'h M. Brain metastases from gynecologic malignancies. Medicina (Kaunas). 2022;58(4):548.
• Wang Q, Zhang F, Gao H, Xu Y. Successful treatment of a patient with brain metastases from endometrial cancer using Niraparib: a case report. Ann Palliat Med. 2021;10(1):818-27.
• Gien LT, Kwon JS, D'Souza DP, Radwan JS, Hammond JA, Sugimoto AK, et al. Brain metastases from endometrial carcinoma: a retrospective study. Gynecol Oncol. 2004;93(2):524-8.
• Uccella S, Morris JM, Multinu F, Cliby WA, Podratz KC, Gostout BS, et al. Primary brain metastases of endometrial cancer: A report of 18 cases and review of the literature. Gynecol Oncol. 2016;142(1):70-5.
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30.
• Kondziolka D, Bernstein M, Resch L, Tator CH, Fleming JFR, Vanderlinden RG, et al. Significance of hemorrhage into brain tumors: Clinicopathological study. J Neurosurg. 1987;67(6):852-7.
• Ulu E, Ozturk B, Atalay K, Okumus IB, Erdem D, Gul MK, et al. Diffusion-weighted imaging of brain metastasis: correlation of MRI parameters with histologic type. Turk Neurosurg. 2022;32(1):58-68.
• Hamed M, Schäfer N, Bode C, Borger V, Potthoff AL, Eichhorn L, et al. Preoperative metastatic brain tumor-associated intracerebral hemorrhage is associated with dismal prognosis. Front Oncol. 2021;11:699860.
• Burth S, Ohmann M, Kronsteiner D, Kieser M, Löw S, Riedemann L, et al. Prophylactic anticoagulation in patients with glioblastoma or brain metastases and atrial fibrillation: an increased risk for intracranial hemorrhage? J Neurooncol. 2021;152(3):483-90.
• Lieschke GJ, Tress B, Chambers D. Endometrial adenocarcinoma presenting as pituitary apoplexy. Aust N Z J Med. 1990;20(1):81-4.
• Vijayakumar V, Rajasundaram S, Prasad PVU, Vimalathithan NS, Saravanan S, Venkatesan R. Brain oligometastasis from synchronous uterine malignancies. Indian J Surg Oncol. 2020;11(Suppl 1):87-9.
• Guyon J, Chapouly C, Andrique L, Bikfalvi A, Daubon T. The normal and brain tumor vasculature: morphological and functional characteristics and therapeutic targeting. Front Physiol. 2021;12:622615.
• Hottinger AF, DeAngelis LM. Etiology of tumor-related intracranial hemorrhage. In: Carhuapoma JR, Mayer SA, Hanley DF, editors. Intracerebral Hemorrhage. New York, USA: Cambridge University Press; 2009. p.31-40.
• Ostrowski RP, He Z, Pucko EB, Matyja E. Hemorrhage in brain tumor - An unresolved issue. Brain Hemorrhages. 2022;3(2):98-102.