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Metastatic Tumors

  • Serge Weis
  • Michael Sonnberger
  • Andreas Dunzinger
  • Eva Voglmayr
  • Martin Aichholzer
  • Raimund Kleiser
  • Peter Strasser
Chapter
  • 379 Downloads

Abstract

Brain metastases are tumors that originate outside the CNS and spread via the hematogenous route to the CNS or (less frequently) directly invade the CNS from adjacent anatomical structures. Primary site for metastases include the respiratory tract, breast, skin (melanoma), gastrointestinal tract, prostate, and kidney. Metastases are usually found in the cerebral hemispheres (80%) in arterial border zones or at the junction of cerebral cortex and white matter.

Radiologically, they are usually round, well-defined enhancing masses with variable edema. In 50% of the cases, the lesions are multiple.

Histologically, a large amount of immunohistochemical profiling is needed to exactly determine the primary site of the metastasis.

Hematogenous metastases results from seeding from the primary tumor, entry into the blood stream, survival in the blood stream, arrival at the point of destination, extravasation into the CNS, and survival and growth in the CNS microenvironment. Molecular pathways involved in the process of metastasis involve migration across BBB, survival in CNS microenvironment, and establishment of radioresistance.

Treatment consists of surgical removal of a single metastasis or of several metastasis, radiotherapy of the whole brain, chemotherapy, and targeted therapy. Outcome depends on Karnofsky performance status (KPS), age of patient, number of CNS metastases, number of sites (CNS and others) for metastases, and responsiveness of primary tumor to therapy.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Serge Weis
    • 1
  • Michael Sonnberger
    • 2
  • Andreas Dunzinger
    • 3
  • Eva Voglmayr
    • 2
  • Martin Aichholzer
    • 4
  • Raimund Kleiser
    • 2
  • Peter Strasser
    • 5
  1. 1.Division of Neuropathology, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  2. 2.Department of Neuroradiology, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  3. 3.Department of Neuro-Nuclear Medicine, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  4. 4.Department of Neurosurgery, Neuromed CampusKepler University Hospital, Johannes Kepler UniversityLinzAustria
  5. 5.PMU University Institute for Medical & Chemical Laboratory DiagnosticsSalzburgAustria

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