Brain metastases of neuroendocrine tumor with unknown primary location - Case report

Neuroendocrine tumors are tumors derived from the cells of the neuroendocrine system. The majority of metastases of neuroendocrine tumors occur in liver, lungs and bone. The brain is an uncommon site of metastasize for this type of tumor. The authors of this paper present a case of brain metastases of neuroendocrine tumor with undetermined primary location. The patient, a 35 yearsold man, was admitted in our clinic with headache, nausea, vomiting and a mild right facial paresis. Head CT scan and cerebral MRI identified two lesions: one larger lesion with mixed solid and cystic components located in the left basal ganglia and thalamus and a second cystic lesion located deep in the right parietal lobe. All complementary investigations (including thoracic CT scan and whole-body MRI) failed to reveal the primary tumor location. Due to the high vital-risks associated with the open surgical procedure, the patient and his family chose the less invasive procedure of stereotactic biopsy. Postoperatively the patient had no additional neurologic deficits, presenting only the initial mild right central facial paresis. The result of immunohistochemistry examination was cerebral metastases of neuroendocrine tumor. The patient was directed to the Institute of Oncology Fundeni for further investigations and therapeutically management. In conclusion, even if these are rare tumors which rarely metastasize in the brain, the neurosurgeons should take in consideration this pathology when they examine a patient with multiple cerebral lesions with unknown location of primary tumor.