Brain metastasis of undifferentiated sarcoma and response to temozolomide treatment. Case report.
A 33-year-old woman presented with rare brain metastases from undifferentiated high-grade sarcoma manifesting as headache and vomiting. Magnetic resonance (MR) imaging demonstrated multiple tumors in the brain, subcutaneous soft tissue, and mediastinum. The patient underwent surgery, followed by chemotherapy and radiotherapy. The histological diagnosis was undifferentiated high-grade sarcoma. Radiotherapy was effective, but the brain tumors recurred 6 months later. The patient underwent high-dose methotrexate therapy, but showed no response. Promoter hypermethylation in the O(6)-methylguanine-deoxyribonucleic acid methyltransferase (MGMT) genes was detected and MGMT protein expression was negative in the recurrent tumor, so temozolomide (TMZ) salvage chemotherapy was given, and follow-up MR imaging showed tumor reduction. This case suggests that TMZ may be effective for brain metastasis of undifferentiated sarcoma without MGMT protein expression.
Tanaka
Hirotomo
H
Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo.
Sasayama
Takashi
T
Nishihara
Masamitsu
M
Arai
Atsushi
A
Kawamura
Atsufumi
A
Kanomata
Naoki
N
Itoh
Tomoo
T
Kohmura
Eiji
E
D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000201:enzymology / Q000235:genetics / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D015254:DNA Modification Methylases / Q000235:genetics / Q000378:metabolism; D045643:DNA Repair Enzymes / Q000235:genetics / Q000378:metabolism; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D020868:Gene Silencing; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000201:enzymology / Q000235:genetics / Q000628:therapy*; D016879:Salvage Therapy; D012509:Sarcoma / Q000201:enzymology / Q000235:genetics / Q000556:secondary / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000201:enzymology / Q000235:genetics / Q000473:pathology / Q000628:therapy; D000077204:Temozolomide; D025521:Tumor Suppressor Proteins / Q000235:genetics / Q000378:metabolism
D018906:Antineoplastic Agents, Alkylating; D025521:Tumor Suppressor Proteins; D003606:Dacarbazine; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes; D000077204:Temozolomide