title: [Histological and molecular analysis of brain metastases].
abstract: The first step in the diagnosis of a metastatic brain lesion is to exclude a primary central nervous sytem tumour, followed by verification or identification of the primary tumor site, in order to guide the clinician to specific therapy. In addition to morphological features, ancillary immunohistochemical study is most effective for the evaluation of a metastatic neoplasm of unknown primary. Although the main principles are same, there are slight variations in the approach to the secondary lesion in the central nervous system versus other regions. Indeed, immunohistochemical approach focuses on the most common tumor types associated with secondary brain colonization: lung cancer, breast cancer and melanoma. Several studies have reported that targeted therapies are capable of reducing brain metastases in melanoma or non-small cell lung cancer, sometimes with a high dramatic response. These results have clearly impacted routine neuropathological practice. It is likely that molecular subtyping of central nervous system metastases will play an increasing role in the future. In accordance with the recommendations of Inca (French national cancer institute), the pathologist develops appropriate strategies for molecular and immunohistochemical analysis, in order to provide results as soon as possible. This article summarizes the diagnosic approach to brain metastases, with a focus on the recent emergence of targeted therapies.
authors: Laboratoire d'anatomie pathologique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; CNRS, UMR 6301 ISTCT, CERVOxy, GIP Cyceron, boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex, France. Electronic address: lechapt-e@chu-caen.fr.
authors: E
authors: E
authors: Lechapt Zalcman
authors: Laboratoire d'anatomie pathologique, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
authors: C
authors: C
authors: Bazille
authors: Département de pathologie cellulaire et tissulaire, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
authors: A
authors: A
authors: Rousseau
authors: Laboratoire central d'anatomie pathologique, centre hospitalier universitaire de Nice, 06000 Nice, France.
authors: F
authors: F
authors: Burel-Vandenbos
authors: Département d'oncologie médicale, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: J-Y
authors: JY
authors: Pierga
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis*; D001932:Brain Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000556:secondary*; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology; D002277:Carcinoma / Q000737:chemistry / Q000145:classification / Q000175:diagnosis / Q000235:genetics / Q000556:secondary; D002454:Cell Differentiation; D005260:Female; D052138:Genes, Neoplasm; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000737:chemistry / Q000175:diagnosis / Q000235:genetics / Q000556:secondary; D009154:Mutation; D009363:Neoplasm Proteins / Q000032:analysis / Q000235:genetics; D009857:Oncogenes
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins
keywords: Biopathologie; Brain metastases; Immunohistochemistry; Immunohistochimie; Marqueurs prédictifs; Marqueurs théranostiques; Métastases cérébrales; Pathobiology; Primitif inconnu; Targeted therapy; Thérapies ciblées; Unknown primary site