Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 4, 2011, pp. 639-640

Neurology India, Vol. 59, No. 4, July-August, 2011, pp. 639-640

Letter to Editor

Hemorrhagic brain metastasis from osteogenic sarcoma of iliac bone in young female: Unusual site of presentation

Amit N. D Dwivedi¹, Prashant K Gupta¹, Kumkum Gupta², Gouri Garg¹

¹ Department of Radiodiagnosis, Imaging and Interventional Radiology, N.S.C.B., Subharti Medical College. Subhartipuram, NH-58, Meerut, India
² Department of Anaesthesiology and Critical Care, N.S.C.B., Subharti Medical College. Subhartipuram, NH-58, Meerut, India
Correspondence Address: Amit N. D Dwivedi, Department of Radiodiagnosis, Imaging and Interventional Radiology, N.S.C.B., Subharti Medical College, Subhartipuram, NH-58, Meerut, India, amitnandan21@yahoo.com

Date of Submission: 11-Mar-2011
Date of Decision: 11-Mar-2011
Date of Acceptance: 14-Mar-2011

Code Number: ni11194

PMID: 21891957

DOI: 10.4103/0028-3886.84361

Sir,

Hemorrhagic brain metastasis from osteogenic sarcoma is very rare and probably supratentorial location has not been reported. We present one such case with sudden onset neurological deficits.

A 22-year-old female presented with sudden onset of right-sided weakness and transient loss of consciousness. These symptoms were associated with headache and vomiting. She was not a known case of hypertension and did not have amenorrhea and had three children. Non-contrast computerized tomography (CT) of head showed multiple hematomas in frontal lobe, not confining to a particular vascular territory [Figure - 1], with significant perilesional edema, extending and compressing the ventricular system. The initial working diagnosis was stroke. Chest radiograph revealed large homogenous opacities in both the lungs with non-segmental distribution which raised suspicion for further investigations. Contrast-CT scan of the chest confirmed bilateral parenchymal mass lesions. Ultrasound abdomen showed right iliac fossa mass. Ultrasound of neck was normal. No lymphadenopathy was noted. CT abdomen showed soft tissue mass, abutting right iliac bone showing lytic lesions and breakdown of cortical outline [Figure - 2]. Fine needle aspiration cytology (FNAC) from right iliac fossa mass and lung lesion revealed highly pleomorphic sarcoma, suggestive of osteogenic sarcoma.

Intarparenchymal hemorrhage in young patients needs, at times, exhaustive investigations. The results may sometimes be very unusual and startling. The conclusion may sometimes be disheartening for an aggressive bone tumor in a young patient. ^[1] In our patient, due to emergency and lack of history made her clinicoradiological diagnosis very challenging. Cases of cerebellar metastasis secondary to osteogenic sarcoma, have been reported but at the late stage of the disease. ^[2] Common causes of hemorrhagic brain metastasis are melanoma,thyroid carcinoma, renal carcinoma and, chorio-carcinoma. ^[3] Osteosarcoma is the most common malignant bone tumor in children and adolescents. ^[4] Iliac bone is not a common site for osteogenic sarcoma in young patients. Brain metastasis from osteosarcoma was once uncommonly reported; however, with the advent of imaging modalities and radionuclide scanning, it has become a more common and recognized finding. Brain metastases are rarely the initial presenting symptom, but occur later phase of the illness and as preterminal event. Brain metastasis from osteosarcomas tend to occur in the gray-white junction in the anterior circulation akin to other metastatic lesions in the brain. ^[5] This case highlights the importance of a meticulous approach to patients admitted to emergency department to locate the primary lesion in metastatic disease presentation. The lack of clinical history and suboptimal physical examination makes the diagnosis more difficult. Hemorrhagic brain metastasis from osteogenic sarcoma with presenting neurological complaints is very rare and anterior circulation involvement is rarely reported in literature.

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