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Mucin
emboli: a rare cause of brain lesions seen in breast adenocarcinoma with
skeletal metastases
John
Finnie, Edward Romond, Roger Fleischman
University
of Kentucky, Lexington, K
We report
a 51 year old patient who presented with a history of breast cancer in 1998
followed by a contralateral primary breast carcinoma diagnosed in 2001.
At the time of the second breast cancer diagnosis, a bone scan revealed multiple
sites of metastasis involving the spine.
Inferior vena cava filter was placed after recurrent lower extremity thrombosis
developed despite coumadin therapy.
Subsequently she was noted to develop mental status changes.
Transient, infrequent episodes of hypoxia also developed as a new problem at
this time, which would quickly resolve with symptomatic treatment.
Gadolinium-enhanced MRI of the brain demonstrated lesions with a curvilinear and
nodular pattern of enhancement in the superficial gray matter atypical for
metastases.
Transthoracic echocardiography revealed no valvular vegetations.
The largest frontal lobe gyral lesion was targeted for stereotactic brain
biopsy, which demonstrated resolving parenchymal hemorrhage without evidence of
tumor. Upon request the cerebral specimen was stained for mucicarmine, revealing
intravascular mucin; staining of the primary breast adenocarcinoma for mucin was
then also found to be positive.
Subsequent spine radiography showed evidence of several recent compression
fractures.
The literature has cited rare reports of mucin emboli from adenocarcinoma, most
often diagnosed historically at necropsy.
Spinal compression fractures noted in our patient may have created intermittent
showers of mucinous material, which have been postulated to traverse the
pulmonary capillary bed and reach the systemic circulation.
Given the history of Greenfield filter placement, episodic mucin emboli were
felt to explain the episodes of transient hypoxemia.
This may be an under-recognized entity among potential intracerebral pathologies
in patients with adenocarcinoma metastatic to bone.
Atypical CNS lesions in this clinical context should be biopsied and stained for
mucin to exclude the possibility of this unusual finding.
© Copyright 2002
American Society of Clinical Oncology
Source:
http://www.asco.org/ac/1,1003,_12-002324-00_18-002002-00_19-002105-00_29-00A-00_42-00ONeill-00_
43-00-00_44-00-00_45-00Author-00_46-00Title-00_47-00Title-00_48-00and-00_49-00and,00.asp?cat=CNS+Tumors&parent
=CENTRAL+NERVOUS+SYSTEM+TUMORS&returnpid=2323
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