KRANIOFACIJALNE METASTAZE ADENOKARCINOMA GASTROINTESTINALNOG POREKLA: IZAZOV U DIJAGNOSTICI

Dražen Radanović; Dušan Micić; Ana Drakul; Marko Đurović; Mihajlo Ćurčić; Marija Rudić; Vanja Mišić Mandić; Sonja Giljača; Emilija Manojlović Gačić

doi:10.5937/zdravzast54-63122

Dražen Radanović Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Republic of Serbia; Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia https://orcid.org/0000-0003-1910-6000
Dušan Micić Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Emergency Center, University Clinical Center of Serbia, Belgrade, Republic of Serbia
Ana Drakul Institute of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Republic of Serbia
Marko Đurović Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Republic of Serbia
Mihajlo Ćurčić Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Republic of Serbia
Marija Rudić Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Department of Anesthesiology and Resuscitation, Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Republic of Serbia
Vanja Mišić Mandić Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Department of Anesthesiology and Resuscitation, Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Republic of Serbia
Sonja Giljača Belgrade City Institute of Public Health, Belgrade, Republic of Serbia
Emilija Manojlović Gačić Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia; Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia

DOI: https://doi.org/10.5937/zdravzast54-63122

Keywords: Adenocarcinoma, gastrointestinal tract, craniofacial metastases, leptomeningeal carcinomatosis, immunohistochemistry, fulminant course

Abstract

Introduction/Aims: Adenocarcinomas of gastrointestinal origin rarely metastasize to the craniofacial region. Such manifestations, especially when associated with suspected leptomeningeal involvement, are characterized by high aggressiveness and a very poor prognosis. The aim of this paper is to present a rare case of a massive craniofacial metastasis from an adenocarcinoma with an atypical presentation and a fulminant clinical course.

Case Report: A retrospective analysis of the medical records of a 74-year-old female patient was performed. The patient was admitted to the Emergency Center due to a sudden disturbance in the level of consciousness. Radiology revealed a massive frontoparietal lesion with extensive destruction of craniofacial bones and invasion of the orbit, sphenoid and temporal bones, and the infratemporal fossa. No primary intraparenchymal brain lesions were observed, but radiological findings suggested leptomeningeal involvement. Metastases were also detected in the liver and vertebral bodies (Th1, L1, L3). Histopathological and immunohistochemical analysis of the craniofacial mass biopsy confirmed an adenocarcinoma with an immunophenotype indicative of gastrointestinal origin. Despite intensive multidisciplinary treatment, the clinical course was fulminant, resulting in a lethal outcome on the fourth day of hospitalization.

Conclusion: Craniofacial metastases of adenocarcinoma can be the first manifestation of an occult gastrointestinal malignancy. Extensive bone destruction and suspected leptomeningeal dissemination lead to an extremely unfavorable outcome. This case highlights the importance of rapid diagnosis and a high degree of clinical suspicion in patients presenting with atypical cranial bone lesions and acute neurological deterioration.

References

Chindamporn T, Srisawat P, Phunmanee A, Boonsupa S, Sookprapha W. Brain Metastasis from Colorectal Cancer: A Review of Systematic Management. J Clin Med. 2023; 12(14): 4662.

Ozdemir N, Ercelep O, Gümüş M, Doğan Ö, Güllü I. Leptomeningeal carcinomatosis from gastrointestinal tumors: A single-center experience. Oncol Lett. 2016; 12(4): 2773-2777.

Huo M, Li J, Sun J, Yang J, Chen P, Zhao L. Skull base metastasis from colorectal adenocarcinoma: A rare case report and review of literature. World J Clin Cases. 2021; 9(22): 6432-6441.

Assi R, Hamieh L, Mukherji D, Haydar A, Khalifeh I, Abou-Alfa GK, et al. Leptomeningeal metastasis as initial manifestation of signet ring colorectal adenocarcinoma: a case report with review of literature. J Gastrointest Oncol. 2015; 6(6): E89-E101.

Taylor G, Karlin N, Halfdanarson TR, Coppola K, Grothey A. Leptomeningeal Carcinomatosis in Colorectal Cancer: The Mayo Clinic Experience. Clin Colorectal Cancer. 2018; 17(2): e183-e187.

Baleiras MM, Graça J, Fernandes L, Chorão M, Vasques AC, Pinto MM. Leptomeningeal carcinomatosis in gastric cancer: a case report of a rare yet aggressive entity. Arch Clin Cases. 2022; 9(1): 6-11.

Mani H, Hossain A, Lee E, Rizvi M. A Rare Case of Duodenal Adenocarcinoma With Brain Metastasis. Cureus. 2024; 16(2): e54287.

Khan SJ, Anum F, Vishal F, Alvi MM, Khan A, Zubair U, et al. A Rare Presentation of Colon Carcinoma Metastasis Within a Meningioma: A Case Report and Literature Review. Cureus. 2023; 15(9): e45764.

Berrada K, Adil H, Bakkari AE, Allioui S, Jerguigue H, Latib R. Rare Cerebrum Metastasis of Intraventricular Colorectal Cancer. Austin J Radiol. 2022; 9(5): 1203.

Duhan S, Keisham B, Duhan C. Duodenal Adenocarcinoma With Suspected Brain Metastasis. Cureus. 2023; 15(5): e39598.

Yamamoto M, Nakazawa N, Ueno M, Sawahata M, Yoshikawa H, Ohta M. A rare case of brain metastasis from poorly differentiated small bowel adenocarcinoma. Ann Case Rep. 2019; 4(16): 1–4.

Paul C, Basu A, Chakravarty A. Leptomeningeal Metastases in Carcinoma Rectum with Extensive Skeletal Metastasis - A Case Report. J Evol Med Dent Sci. 2023; 12(10): 308–312.

Mullangi S, Lekkala MR. Adenocarcinoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562137/

CRANIOFACIAL METASTASES OF GASTROINTESTINAL ADENOCARCINOMA: A DIAGNOSTIC CHALLENGE

Abstract

References