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Metastasizing breast carcinoma to middle cranial fossa with extensive hyperostosis which occurred 8.5 years after the initial treatment

  • Mohammad Ali Akbar ,
  • Muhammad Kamil ,
  • F M Moinuddin ,
  • Shingo Fujio ,
  • Hirofumi Hirano ,
  • Takuichiro Higashi ,
  • Junko Kawano ,
  • Ikumi Kitazono ,
  • Arie Ibrahim ,
  • Yuriz Bakhtiar ,
  • Thohar Arifin ,
  • Zainal Muttaqin ,
  • Kazunori Arita ,


Introduction: Breast cancer is the second most common primary tumor with brain metastases. Breast cancer metastasizing to the neurocranium can include the skull, dura, or parenchyma of the brain. Skull metastases were most often found in the breast, typically presenting as osteolytic.

Case Presentation : A 53-year-old woman with a history of breast cancer surgery 8.5 years before she had a headache , nausea, and right visual disturbance. Neuroimaging studies have identified a large tumor in the anterior part of the right middle cranial fossa associated with severe hyperostosis of the underlying bones. Intraoperative exposure revealed that the primary tumor site was dura mater of the middle cranial fossa. The tumor has been histologically diagnosed as metastatic breast carcinoma with sphenoid bone invasion.  

Conclusion: Dural breast cancer metastasis may pose this uncommon characteristic of severe hyperostosis, which should be considered in primary skull tumor differential diagnosis.

Key words: Hyperostosis, Brain metastasis, Breast cancer, skull base tumor


  1. Schouten LJ, Rutten J, Huveneers HA and Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94: 2698-2705, 2002.
  2. Yeh RH, Yu JC, Chu CH, et al. Distinct MR Imaging Features of Triple-Negative Breast Cancer with Brain Metastasis. J Neuroimaging 25: 474-481, 2015.
  3. Lin NU. Breast cancer brain metastases: new directions in systemic therapy. Ecancermedicalscience 7: 307, 2013.
  4. Stark AM, Eichmann T and Mehdorn HM. Skull metastases: clinical features, differential diagnosis, and review of the literature. Surg Neurol 60: 219-225; discussion 225-216, 2003.
  5. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347: 1233-1241, 2002.
  6. Palbociclib ups PFS in HER2-/ER+ breast cancer. Cancer Discov 4: 624-625, 2014.
  7. Heitz F, Harter P, Lueck HJ, et al. Triple-negative and HER2-overexpressing breast cancers exhibit an elevated risk and an earlier occurrence of cerebral metastases. Eur J Cancer 45: 2792-2798, 2009.
  8. Nayak L, Abrey LE and Iwamoto FM. Intracranial dural metastases. Cancer 115: 1947-1953, 2009.
  9. Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J and Delattre JY. Skull-base metastases. J Neurooncol 75: 63-69, 2005.
  10. Mitsuya K, Nakasu Y, Horiguchi S, et al. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol 104: 239-245, 2011.
  11. Guise TA, Mohammad KS, Clines G, et al. Basic mechanisms responsible for osteolytic and osteoblastic bone metastases. Clin Cancer Res 12: 6213s-6216s, 2006.
  12. Bendre MS, Margulies AG, Walser B, et al. Tumor-derived interleukin-8 stimulates osteolysis independent of the receptor activator of nuclear factor-kappaB ligand pathway. Cancer Res 65: 11001-11009, 2005.
  13. Yin JJ, Mohammad KS, Kakonen SM, et al. A causal role for endothelin-1 in the pathogenesis of osteoblastic bone metastases. Proc Natl Acad Sci U S A 100: 10954-10959, 2003.
  14. Talacchi A, Corsini F and Gerosa M. Hyperostosing meningiomas of the cranial vault with and without tumor mass. Acta Neurochir (Wien) 153: 53-61; discussion 61, 2011.
  15. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322: 494-500, 1990.
  16. Stark AM, Stohring C, Hedderich J, Held-Feindt J and Mehdorn HM. Surgical treatment for brain metastases: Prognostic factors and survival in 309 patients with regard to patient age. J Clin Neurosci 18: 34-38, 2011.
  17. Di Leo A, Jerusalem G, Petruzelka L, et al. Results of the CONFIRM phase III trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer. J Clin Oncol 28: 4594-4600, 2010.

How to Cite

Akbar, M. A., Kamil, M., Moinuddin, F. M., Fujio, S., Hirano, H., Higashi, T., Kawano, J., Kitazono, I., Ibrahim, A., Bakhtiar, Y., Arifin, T., Muttaqin, Z., & Arita, K. (2020). Metastasizing breast carcinoma to middle cranial fossa with extensive hyperostosis which occurred 8.5 years after the initial treatment. Indonesian Journal of Neurosurgery, 3(3).