title: CLL cells in a brain metastasis of bronchial adenocarcinoma in a patient with three different neoplasms - case report.
abstract: OBJECTIVE
  We report the case of a patient with three different malignancies who had a brain metastasis of bronchial adenocarcinoma with infiltrates of CLL lymphocytes and who had been operated for prostate cancer years before. -
  
  
  RESULTS
  A 72-year-old man was admitted to our department after a Jacksonian seizure. The MRI showed a left temporal mass lesion. The patient was suffering from chronic lymphocytic leukemia (CLL) for ten years, he had had surgery for prostate cancer eight years ago and the diagnosis of bronchial carcinoma was made during preoperative routine diagnostics. After neurosurgical intervention the histologic examination of the cerebral mass lesion disclosed metastasis of a PSA-negative adenocarcinoma with perivasal infiltrates of lymphocytic leukemic cells. -
  
  
  CONCLUSIONS
  There are few reports about patients with three primary malignancies. CLL may play a role in enabling tumor cells to escape the immune response and could facilitate development of the prostate cancer and of a bronchial adenocarcinoma as secondary cancers in this patient. The combined occurrence of adenocarcinoma cells and CLL lymphocytes in the brain metastasis can be explained by impairment of the blood-brain-barrier in the carcinoma metastasis enabling extravasation of circulating leukemic cells.
authors.affiliation: Neurochirurgische Klinik, Justus-Liebig-Universität, Giessen. ulf.nestler@neuro.med.uni-giessen.de
authors.forename: U
authors.initials: U
authors.lastname: Nestler
authors.forename: W
authors.initials: W
authors.lastname: Deinsberger
authors.forename: S
authors.initials: S
authors.lastname: Grumbrecht
authors.forename: K
authors.initials: K
authors.lastname: Kuchelmeister
authors.forename: D K
authors.initials: DK
authors.lastname: Böker
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000556:secondary / Q000601:surgery; D014057:Tomography, X-Ray Computed