Brain metastases of cancer of unknown primary: presentation of clinical cases

Abstract

Background. Metastases to the brain (brain metastases (BM)) are the most common intracranial tumors in adults and occur 3–10 times more frequently than primary brain tumors. In 15% of patients with BM, the primary tumor cannot be determined, which is known as BM cancer of unknown primary. Cancer of unknown primary is the seventh/eighth common malignancy and the fourth leading cause of cancer-related death, often characterized by early and aggressive metastatic spread, poor response to chemotherapy, and poor prognosis. Purpose – To study the course of brain metastases in cancer of unknown primary on the example of clinical cases. Materials and methods. Clinical observation of male patient N., 50 years old, who was diagnosed with a metachronous disease with metastatic damage to the lymph nodes, the excisional biopsy of which established a metastasis of squamous non-keratinous carcinoma and a solitary voluminous neoplasm of the brain, which during the initial examination was considered as IV glioma. Clinical observation of patient B., 40 years old, in whom the primary manifestation of the disease was a solitary neoplasm of the brain, the pathohistological examination of which was regarded as a metastasis of grade III small cell neuroendocrine carcinoma, but the localization of the primary cancer was not established. The examination and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine». Results. The clinical cases of BM cancer of unknown primary in two patients aged 50 and 40 years old, which according to histopathological examination were probably low-differentiated squamous cell adenocarcinoma, are presented. The difficulties of diagnostic search for primary cancer and treatment of such patients are shown. Conclusion. Brain metastases cancer of unknown primary, as well as the differential diagnosis of primary brain gliomas and solitary metastases, remain a complex diagnostic and therapeutic medical problem that is a challenge for oncologists, neurosurgeons and neurologists alike. Further study of this problem is necessary for the effective treatment of such patients.