Breast adenocarcinomas (ACMs) are malignant neoplasms that frequently disseminate both hematogenously and to the brain parenchyma. occurs despite the brain’s lack of a conventional lymphatic drainage system, with metastasis primarily facilitated through the attachment of tumor cells to the endothelium of brain vasculature, allowing their infiltration into the bloodstream [1].
Neuroendocrine tumors, though rare, affect various organs, including the lungs, pancreas, and gastrointestinal tract. Neuroendocrine breast carcinomas constitute a mere 0.5% of cases and were first described in 1977. They exhibit immunohistochemical positivity for neuroendocrine markers in 50% of cases. According to the 2012 World Health Organization (WHO) classification, they are categorized into well-differentiated, poorly differentiated, or invasive carcinomas with neuroendocrine differentiation based on the degree of marker expression [2].
Brain metastases from breast cancer remain a significant clinical challenge, often managed through chemoradiation, which improves systemic disease control. Agents such as cisplatin and vinorelbine have shown efficacy in controlling toxicity and improving therapeutic outcomes in breast cancer patients with brain metastases [3]. Specific sites of metastasis, such as the cerebral fornix, are associated with symptoms like memory deficits, nausea, vomiting, and headaches. Hormone receptor therapies have demonstrated considerable efficacy in cases of breast cancer metastasized to the cerebral fornix [4].
The treatment of breast cancer with brain metastases is complex, depending on factors like tumor characteristics, patient comorbidities, and lesion size, shape, and number. Whole-brain radiotherapy (WBRT) remains a cornerstone of therapy and is frequently combined with surgical resection in appropriately selected patients [5].
A 57-year-old woman were brought to the emergency department after being found unconscious by a family member who promptly contacted emergency services. On arrival, the patient underwent a comprehensive evaluation. On initial examination, her Glasgow Coma Scale (GCS) score was 7, indicative of significant neurological impairment. Pupillary assessment revealed asymmetry, anisokoria, and sluggish reactivity, which suggested focal neurological deficits. Motor strength was noted to be 3/5 bilaterally, while no abnormalities were observed in cranial nerve function. The patient’s vital signs were stable. Past Medical History: The patient had a complex medical history, including chronic normochromic normocytic anemia of moderate severity and a diagnosis of left breast cancer (T2N0M0, stage 2A) for which she had undergone a left radical mastectomy and eight cycles of chemotherapy. MRI: A series of axial, sagittal, and coronal MRI scans were performed using T1, T2, and FLAIR imaging sequences. The scans revealed a 0.65 cm leftward shift of the midline structures. The posterior horn of the right lateral ventricle was deformed by a cystic lesion located in the right parieto-occipital region, accompanied by pronounced perifocal edema. Diagnosis: Intracerebral mass (tumor) in the right occipital lobe. A stroke was initially suspected, prompting immediate admission for further investigations and preparation for potential surgical intervention. The treatment decision was surgical intervention with an osteoplastic craniotomy. The occipital mass was shown in Figure 1, 2.
The objective of this study is to analyze the therapeutic effect of brain metastasis from its origin, improving the patient’s quality of life through the surgical process.
The patient underwent osteoplastic craniotomy in the right occipital region for tumor excision. Surgical Approach and Description of the Operation. Patient Positioning and Preparation: The patient was placed prone with the head secured in a Mayfield clamp.
Incision and Exposure: A midline incision was made through the skin and aponeurosis along the projection of the nuchal line. The overlying muscles were carefully retracted with a surgical retractor to expose the occipital bone. A 3 × 3 cm portion of the occipital bone was removed to the right of the nuchal line, starting from the first burr hole.
A 4 cm diameter burr hole was made from a burr hole using a craniotome. The dura mater is taut and nonpulsatile. After the tumor boundaries were clarified by ultrasound (Logic P6 device), the dura mater was opened in a horseshoe shape and the tumor cyst was drained. The contents of the cyst (clear xanthochromic fluid) were taken for cytological examination. Tumor tissue was found in the posterior wall of the cyst, represented by a nodule with inclusions of thrombosed vessels. Using microsurgical techniques, the nodule was excised and sent for histological examination. Hemostasis with fibrillar material. The dura mater is firmly sutured. The bone flap is placed in place and fixed with two craniofixations. The wound is sutured layer by layer. Aseptic etiquette. Closure and drainage: After hemostasis was verified, the dura mater was left open, and sialoplasty was performed with the aponeurosis of the occipital muscle. Protecting of the large blood vessels and functional brain tissues was conducted during the operation. Postoperatively, she received a comprehensive treatment regimen, including antibacterial, anticonvulsant, and hormonal therapies.
Follow-up imaging by CT scan after surgical intervention revealed a reduction in the midline shift to 7.3 mm and a decrease in perifocal edema. A residual cystic cavity with minor hemorrhagic components was visualized in the right occipital lobe. Postoperative imaging revealed signs of pneumocephalus, with a subcutaneous hematoma.
Following the surgical removal of the intracerebral tumor in the right occipital lobe, the patient was closely monitored in the intensive care unit (ICU). Postoperative CT imaging revealed a reduction in the displacement of midline structures, a residual cystic cavity with hemorrhagic density inclusions, and decreased perifocal edema, consistent with expected postoperative changes. Postoperative management included a multidisciplinary therapeutic approach consisting of antibacterial therapy, anticonvulsant therapy, infusion therapy, hormonal therapy, antihypertensive therapy, and symptomatic treatment. After one month and 3 weeks, the patient was discharged.