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Abstract：
BACKGROUND: Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000-2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved.
METHODS: Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area.
CONCLUSIONS: ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.
METHODS: Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area.
CONCLUSIONS: ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.
摘要：
背景：原发性中枢神经系统（CNS）肿瘤的神经外/颅转移（ENM）很少见，可能在诊断上具有挑战性。我们描述了通过细针穿刺（FNA）评估的病例系列中ENM的细胞形态学和相关临床特征。对多伦多2个三级护理中心（2000-2015年）的实验室信息系统进行了搜索。排除了中枢神经系统肿瘤直接颅外/脊髓延伸的病例。回顾了FNA的显微镜载玻片和手术标本。检索人口统计学和临床病理数据。
方法：6例最初诊断为胶质母细胞瘤，具有原始神经外胚层肿瘤样成分的胶质母细胞瘤，间变性室管膜瘤,粘液乳头状室管膜瘤，非典型脑膜瘤，血管外皮细胞瘤.首次诊断时的中位患者年龄为44岁（范围22-56）。初次诊断与首次转移疾病表现之间的时间间隔为3个月至19年。所有FNA诊断均正确呈现。在4个案例中，免疫组织化学用于支持诊断。所有病例均在原发肿瘤部位进行了手术干预。在4个案例中，ENM位置为同侧腮腺或颊区.中线位置的两个原发性肿瘤在肩胛骨区域发展为ENM。
结论：ENM是一系列不同原发性中枢神经系统肿瘤的罕见表现，可能涉及临床上模仿涎腺肿瘤的同侧头颈部。FNA可以快速区分ENM和其他，潜在的更惰性的条件。了解临床病史对于避免诊断混乱至关重要。
方法：6例最初诊断为胶质母细胞瘤，具有原始神经外胚层肿瘤样成分的胶质母细胞瘤，间变性室管膜瘤,粘液乳头状室管膜瘤，非典型脑膜瘤，血管外皮细胞瘤.首次诊断时的中位患者年龄为44岁（范围22-56）。初次诊断与首次转移疾病表现之间的时间间隔为3个月至19年。所有FNA诊断均正确呈现。在4个案例中，免疫组织化学用于支持诊断。所有病例均在原发肿瘤部位进行了手术干预。在4个案例中，ENM位置为同侧腮腺或颊区.中线位置的两个原发性肿瘤在肩胛骨区域发展为ENM。
结论：ENM是一系列不同原发性中枢神经系统肿瘤的罕见表现，可能涉及临床上模仿涎腺肿瘤的同侧头颈部。FNA可以快速区分ENM和其他，潜在的更惰性的条件。了解临床病史对于避免诊断混乱至关重要。
