Histopathologic diagnosis of brain metastases: current trends in management and future considerations

Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. Apart from morphological features, ancillary immunohistochemical analysis is the most effect...

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Bibliographic Details
Published in:Brain tumor pathology 2017, Vol.34 (1), p.8-19
Main Authors: Bekaert, Lien, Emery, Evelyne, Levallet, Guénaëlle, Lechapt-Zalcman, Emmanuèle
Format: Article
Language:English
Subjects:
Animals
Antibodies
Antigens
Biomarkers, Tumor - analysis
Brain - pathology
Brain cancer
Brain Neoplasms - diagnosis
Brain Neoplasms - pathology
Breast cancer
Cancer Research
Cytokeratin
Epidermal growth factor
Humans
Kinases
Life Sciences
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - pathology
Medicine
Medicine & Public Health
Melanoma
Melanoma - diagnosis
Melanoma - pathology
Metastasis
Morphology
Mutation
Neoplasms, Second Primary - diagnosis
Neoplasms, Second Primary - pathology
Neurology
Neurosurgery
Oncology
Pathology
Proteins
Review Article
Sarcoma
Thyroid gland
Transcription factors
Tumors
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Summary:Confronted with brain metastases (BM), pathologists aim to rule out a primary central nervous system (CNS) tumor and to identify or verify the primary tumor site to guide the clinician to specific therapies. Apart from morphological features, ancillary immunohistochemical analysis is the most effective tool for characterizing a metastatic neoplasm of unknown origin. A limited array of antibodies is used, taking into account relevant clinical information and the known brain tropism of lung cancer, breast cancer and melanoma. Recently, targeted therapies have enriched the therapeutic arsenal, in particular for patients with non-small cell lung cancer or melanoma and for patients carrying molecular anomalies. These therapies can lead to a substantial tumor response, brain metastases included, which justifies rapid determination of a molecular profile. To combine different tools and provide timely results, good tumor sample management and careful attention at the pre-analytical phase are critical. Appropriate strategies for molecular and immunohistochemical analysis are needed to identify theranostic markers. This article aims to review the anatomopathological diagnostic approach for BM in the age of targeted therapies.
ISSN:1433-7398
1861-387X
DOI:10.1007/s10014-016-0275-3