title: Brain metastases as primary manifestation of a melanocytic malignant peripheral nerve sheath tumor in a 60-year-old man.
abstract: BACKGROUND
  Malignant peripheral nerve sheath tumors are rare tumor entities that originate from peripheral nerve sheaths and have an unfavorable prognosis. Metastatic spread to the cerebral parenchyma is absolutely rare. This case report describes the clinical course in a 60-year-old man whose tumor came to medical attention because of a seizure.
  
  
  METHODS
  Magnetic resonance imaging demonstrated two intracerebral lesions. The symptomatic lesion was removed microneurosurgically and histology demonstrated a metastasis from a malignant peripheral nerve sheath tumor. Postoperatively, whole-brain irradiation was performed. The primary tumor was identified in the area of the sciatic nerve on the right. Follow-up 14 months after resection showed that there was no progression of the intracerebral lesions but an increase in size and number of distant metastases.
  
  
  CONCLUSIONS
  There are no generally accepted guidelines for the treatment of malignant peripheral nerve sheath tumors with cerebral metastases. This case report presents and discusses one possible therapeutic approach. Due to the poor overall prognosis, the least invasive therapy should be chosen.
authors.affiliation: Dept. of Stereotactic Neurosurgery, Universitätsklinik Freiburg, Germany. Johannes.Tilgner@med.uni-heidelberg.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Tilgner
authors.forename: Klaus
authors.initials: K
authors.lastname: Müller
authors.forename: Nadir
authors.initials: N
authors.lastname: Ghanem
authors.forename: Johannes
authors.initials: J
authors.lastname: Lutterbach
authors.forename: Jan
authors.initials: J
authors.lastname: Vesper
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D011859:Radiography