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Int J Clin Exp Pathol 2011;4(5):xxx-xxx

Original Ariticle
Dural-based metastatic carcinomas mimicking primary CNS neoplasia: report of 7 cases
emphasizing the role of timely surgery and accurate pathologic evaluation

Natasha M Savage, Cargill H Alleyne, John R Vender2, Ramon Figueroa, Hui Zhang, Thomas A Samuel, Suash Sharma

Pathology, Georgia Health Sciences University, Augusta, Georgia, United States; Neurosurgery, Georgia Health Sciences University, Augusta,
Georgia, USA; Radiology, Georgia Health Sciences University, Augusta, Georgia, USA; and Medicine, Section of Hematology/Oncology, Georgia
Health Sciences University, Augusta, Georgia, USA.

Received June 3, 2011; accepted June 15, 2011; Epub June 16, 2011; published June 20, 2011

Abstract: Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in
guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas.  Following the receipt of
HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6
meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records
and follow-up data were reviewed.  Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous
but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic
carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and “picket-fence” like glands were among useful histologic
diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases.  Subsequent clinical and radiologic evaluation confirmed
coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which
interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of
unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery.  Although high-
grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor
site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians
and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic
carcinomas. (IJCEP1106001)

Keywords: Meningioma, metastatic carcinoma, radiology, Immunohistochemistry, frozen section

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Address all correspondence to:
Natasha M Savage, MD
Department of Pathology
Georgia Health Sciences University
1120 15th Street
Augusta, GA 30912
Tel: (706) 721-2611
Fax: (706) 721-6898