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CEREBRAL METASTATIC CHONDROSARCOMA AND BREAST CARCINOMA - REPORT OF A RARE CASE AND LITERATURE REVIEW Free

INTRODUCTION: Chondrosarcoma is the 2nd commonest primary malignancy of the mesenchyme after osteosarcoma. Distant metastases occur in 10% of grade II and 71% of grade III tumours, commonly in lung, bones and liver, resulting in a 5-year survival of 18%. Cerebral metastases (CMs) are exceedingly rare. METHOD: A 56-year old woman, underwent local excision of a left shoulder girdle grade I chondrosarcoma 2 years ago. This recurred rapidly; 9 months later, she underwent total scapulectomy which showed mainly grade I tumour, with focal areas of grades II/III and no dedifferentiation. Resection margins were clear. Twelve months ago, she developed pulmonary metastases confirmed with biopsy. While considering for pazopanib treatment (EORTC PALETTE trial, 2012), the patient developed morning headache, sickness and a right inferior homonymous quadrantanopia. MRI revealed a left parieto-occipital intrinsic tumour, measuring 38mm. Within a month, it increased to 58mm. Her medical history included breast carcinoma 12 years ago treated with surgery, chemo- and radiotherapy. She underwent craniotomy and resection of the cerebral tumour, which was grade II chondrosarcoma. She subsequently underwent radiotherapy. RESULTS: Only 10 cases of CMs have been reported; the majority also had pulmonary metastases. The present case highlighted the rapid radiological progression of CM, which was not previously described. Recent clinical and genetic studies suggested a syndrome of co-occurrence of breast carcinoma and chondrosarcoma. CONCLUSION: We recommend urgent resection surgery for disease control and diagnosis, especially if the patient has another primary malignancy. The efficacy of pazopanib in CMs need further evaluation.