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Intravascular carcinomatosis of the brain: a report of two cases

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Abstract

Although central nervous system (CNS) metastases are common in advanced cancer, CNS involvement solely by intravascular tumor cells, known as intravascular carcinomatosis, is extremely rare. We report two cases of brain metastasis in which tumor cells were restricted to the vascular lumina without parenchymal involvement, resulting in ischemic lesions. The first patient is a previously healthy young woman who presented with symptoms of community-acquired pneumonia and progressed to respiratory failure. Computed tomography of the brain showed infarcts of differing ages. At autopsy, she was found to have widely metastatic cervical squamous cell carcinoma and cerebral tumor emboli with multifocal infarcts, mainly microinfarcts. The second patient is an elderly man with cognitive impairment and mild Parkinsonism who presented with symptoms of a urinary tract infection. Magnetic resonance imaging of the brain showed atrophy and changes suggestive of chronic microvascular ischemic disease. Postmortem examination demonstrated prostatic adenocarcinoma and cerebral tumor emboli with multifocal infarcts. These cases illustrate that this pattern of intracranial metastasis may rarely be a cause of cerebral ischemic lesions and emphasize the importance of thorough pathologic examination of the brain.

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Acknowledgements

The authors would like to thank Dr. Gregory Fishbein (UCLA Medical Center) for his expertise on the autopsy findings for patient 2.

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Correspondence to Shino Magaki.

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Chan, J., Magaki, S., Zhang, X.R. et al. Intravascular carcinomatosis of the brain: a report of two cases. Brain Tumor Pathol 37, 118–125 (2020). https://doi.org/10.1007/s10014-020-00367-x

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