CNS tumor
Metastatic tumors to CNS

Topic Completed: 1 January 2006

Minor changes: 27 June 2020

Revised: 3 January 2019, last major update January 2006

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

PubMed search: Metastatic carcinoma CNS [title]

Nat Pernick, M.D.
Page views in 2019: 2,600
Page views in 2020 to date: 1,557
Cite this page: Pernick N. Metastases-general. website. Accessed July 4th, 2020.
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:

Case of Week #222 - alveolar soft part sarcoma:






Images contributed by 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
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