Pathology for Neurosurgery & Neurology
Department of Pathology
University of Oklahoma Health Sciences Center,
Oklahoma City, OK, U.S.A.
Online Slide Case 4
History: The patient was a 50 year-old woman who was in
good health until breast cancer was discovered about a year
ago. Shortly after, a parietal ring enhancing mass was
discovered and she was referred to the neurosurgery service.
Contributor: Kar-Ming Fung, M.D., Ph.D., firstname.lastname@example.org Last updataded: 4/20/2009
A solitary parietal lobe lesion with an enhancing rim associated with substantial
edema is present.
The cells have large nuclei, prominent nucleoli, and substantial variation in
nuclear size. Also present are multiple large cytoplasmic vacuoles. This type of
vacuoles (arrow) are rather common in mucin producing adenocarcinoma.
There is extensive gland formation with mucin production (arrow) and necrosis
There is extensive necrosis (N). The tumor (arrow) is well demarcated from the
surrounding brain parenchymal tissue (B). Metastatic carcinoma and melanoma
are usually well demarcated from the residual brain parenchymal tissue.
The tumor cells have large nuclei and
(+), TTF-1 (-), CK7 (+), CK20 (-).
Diagnosis: Metastatic adenocarcinoma of breast origin.
• The history and the imaging clearly suggest a metastatic carcinoma. Most
metastasis to the brain are of pulmonary origin.
• Histologically, carcinoma cells like to stay in clusters and are well demarcated
from the residual brain tissue. Necrosis is often, but not always, present and
may be extensive enough that only a small amount of viable tumor cells are
• The following immunohistochemical profile is compatible with breast origin.
GCDFP15 is often positive in breast adenocarcinoma and TTF1 is positive in
most pulmonary adenocarcinoma. The results on CK7 and CK20 do not help
to distinguish one from the other.
Thyroid transcription factor 1 (TTF-1): Negative.
Gross cystic disease fluid protein 15 (GCDFP15): Positive
CK7: Positive, CK20: Negative
• The interesting feature of this case is the substantial mucin production which
is not a very common feature in metastatic breast adenocarcinoma.