CNS tumor
Metastatic tumors

Author: Nat Pernick, M.D. (see Authors page)

Revised: 19 May 2017, last major update January 2006

Copyright: (c) 2006-2017,, Inc.

PubMed search: Metastatic carcinoma CNS [title]

Cite this page: Metastases to CNS - General. website. Accessed August 17th, 2017.
Definition / general
  • Most common brain tumors in community hospitals are metastases (50% of intracranial tumors in hospitalized patients)
    • Primary is usually known: melanoma or carcinoma (lung, breast, kidney and GU), occasionally germ cell tumor
    • Common with choriocarcinoma
    • Common presentation is adult with seizures or ataxia
    • Dural metastases are often from breast and prostate, but also unusual primaries; may have survival of 2+ years (Arch Pathol Lab Med 2001;125:880)
  • Metastases to vertebral column: often prostate, breast or hematopoietic neoplasm
  • Metastases with unknown primary: lung, colon, kidney
  • Multiple lesions are suggestive of metastasis vs. primary CNS tumor
  • Usually to cerebrum, but no distinct patterns

Meningeal carcinomatosis:
  • Represents 4-8% of metastatic brain tumors
  • Diffuse spread of tumor in subarachnoid space
  • Associated with carcinoma of lung and breast and ALL
  • Poor prognosis
  • Repeat lumbar punctures and immunocytochemistry may be helpful in differentiating from aseptic meningitis (Arch Pathol Lab Med 2000;124:759)
Prognostic factors
  • Favorable prognostic factors: single metastasis, younger age, surgical resection of metastasis, primary in lung (non-small cell), breast, melanoma, renal cell or ovary
Case reports
Meningeal carcinomatosis:
Gross description
  • Sharply demarcated lesion at gray-white matter junction, surrounded by edema
Gross images

Image hosted on other servers:

Lung metastasis

Microscopic (histologic) description
  • Epithelial cells with discrete cell boundaries, pushing margin except for small cell carcinoma (infiltrative)
Microscopic (histologic) images

Images hosted on PathOut server, courtesy of Dr. Ankur Sangoi, El Camino Hospital, Mountain View, California:

Case of the Week #425, metastatic lung adenocarcinoma, ALK-rearranged

Case of the Week #425, metastatic lung adenocarcinoma, ALK-rearranged

COW #425, NapsinA

COW #425, TTF1

COW #425, ALK break-apart FISH images (ALK gene in RED)

Images hosted on other servers:

External ear canal: adenoid cystic carcinoma

Meningeal carcinomatosis:

Gallbladder adenocarcinoma
Fig 2: gallbladder; 3: leptomeninges

Kidney: collecting duct
meningeal carcinomatosis

Cytology images

Images hosted on other servers:

Metastatic GI carcinoma (signet ring cells)

Recommended stain panels

  • General: TTF1 (lung and thyroid, Hum Pathol 2002;33:642), cytokeratin and CAM 5.2, CK7, CK20 and PSA
  • Breast carcinoma: CK7+, CAM5.2+, CK20-, TTF1-
  • Lung adenocarcinoma: CK7,+ CAM5.2+, TTF1+, CK20-
  • Colon carcinoma: CK20+, CK7-, TTF1-
  • Renal cell carcinoma: RCC+, CAM5.2+, vimentin+
Differential diagnosis