title: Detection of circulating tumor cells in the cerebrospinal fluid of a patient with a solitary metastasis from breast cancer: A case report.
abstract: Brain lesions identified following the diagnosis and eradication of primary cancers are often ambiguous in origin, existing as a solitary metastasis or an independent primary brain tumor. The brain is a relatively common site of metastasis with breast cancer, although determining whether metastases have originated from the breast or brain is often not possible without invasive biopsies. In the current case report, a patient presented with a brain lesion identified by radiography and was without systemic disease. The patient had previously exhibited a complete response to chemotherapy and surgery for a poorly differentiated invasive ductal carcinoma. The origin of the brain lesion could not be determined by magnetic resonance imaging, giving rise to a diagnostic dilemma with diverging treatment options. We previously reported a method to isolate and enumerate tumor cells of epithelial origin in the cerebrospinal fluid (CSF). CSF tumor cell analysis of the patient revealed massive CSF tumor cell burden of epithelial origin, indicating that the brain lesion was likely of breast origin. The current case report highlights the use of CSF tumor cell detection as a differential diagnostic tool, in addition to its previously demonstrated use as a marker of disease burden and therapeutic response.
authors.affiliation: Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA ; Department of Neurological Surgery, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Akshal S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Allen
authors.affiliation: Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Dicker
authors.affiliation: Department of Neurological Surgery, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Sheehan
authors.affiliation: Department of Neurological Surgery, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Glantz
authors.affiliation: Laboratory of Translational Oncology and Experimental Cancer Therapeutics, Department of Medicine (Hematology/Oncology), Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA.
authors.forename: Wafik S
authors.initials: WS
authors.lastname: El-Deiry
keywords: brain lesion; brain metastasis; cerebrospinal fluid; leptomeningeal disease; metastatic breast cancer