Abstract

Introduction: Dissemination of breast cancer to the central nervous system (CNS) occurs in 15%-30% of patients with invasive breast cancer. There are three distinct patterns for the occurrence of brain metastases: about 10% of people diagnosed with breast cancer will develop brain metastases during the first year from the diagnosis of the primary tumor; bimodal recurrence of central nervous system (CNS) metastasis occurring within 2 years from the initial breast cancer diagnosis; delayed recurrence of brain metastases, occurring more than 4-5 years after breast cancer diagnosis.

Material and method: We present the case of a female patient, 63 years old, who was admitted in the Neurosurgery Clinic of “Prof. Dr. N. Oblu” Emergency Clinical Hospital from Iasi, Romania, for: headaches, dizziness, aphasia of expression, and right hemiparesis with progressive evolution. Her personal medical history revealed a right breast carcinoma, which was diagnosed and surgically treated in 2017.

Results and discussion: The Magnetic Resonance Imaging (MRI) identified an intraaxial inhomogeneous solid formation, located on the left, at the level of the insula, external capsule, extreme capsule, in putamen and in the corona radiata, with the suspicion of a metastasis from the breast cancer. There were also two other solid extraaxial formations, one in the left temporal region, and the other one in the left posterior parietal region, which, due to patient's personal medical history and tumor locations, were difficult to be diagnosed as two meningiomas or two dural metastases. The surgeons excised the intraaxial tumor, which was pathologically diagnosed as a metastasis from the breast carcinoma, and the extraaxial left temporal tumor, which, from a histopathological point of view, proved to be an atypical meningioma.

Conclusion: The simultaneous occurrence of an intracranial meningioma and a single metastasis in the same patient is an unusual event. The presented case demonstrates that when multiple intracranial tumors are present in a patient with a known extracranial cancer, they should not always be regarded as metastases.