Faculty Bibliography

Dural metastasis of metastatic breast cancer has become an increasingly diagnosed entity due to advanced radiological imaging. We present an autopsy case of a 51-year-old woman who presented with dizziness, had dural metastasis with subdural hematoma from a primary high-grade invasive ductal breast carcinoma. The pathogenesis of dural metastasis in our case was due to hematogenous dissemination while the subdural hematoma was due to destruction of vessels by tumor cells. The postmenopausal age and the high-grade histology of our case according to published literature signify a poor prognosis and would have meant an ante mortem median survival time of less than one year. Several studies have shown that treatment of intracranial metastatic cancer improves survival. Early recognition and diagnosis of symptoms of dural metastasis will alleviate the neurological complications of dural metastatic breast cancer. Our case report attempts to contribute to the understanding of dural metastasis in breast cancer and emphasize the importance of CNS surveillance in the treatment of a systemic primary cancer.

INTRODUCTION/BACKGROUND:The association of thymoma with myasthenia gravis (MG) is well known. Thymoma with sarcoidosis however, is very rare. We presented an interesting case with coexisting thymoma, MG and sarcoidosis. CASE PRESENTATION/METHODS:A 59-year-old female patient with a history of sarcoidosis was admitted to the hospital with a one-day history of sudden onset of right-sided partial ptosis and diplopia. Neurosarcoidosis with cranial nerve involvement was considered, but was ruled out by the clinical findings, and MG was confirmed by the positive tensilon test, electrophysiological findings and positive acetylcholine receptor binding antibodies. On further evaluation, a CT chest scan showed a left anterior mediastinal mass and bilateral lymphadenopathy. Post surgical diagnosis confirmed the thymoma and sarcoidosis in the lymph nodes. CONCLUSION/CONCLUSIONS:When two or more diseases of undetermined origin are found together, several interesting questions are raised. It is important to first confirm the diagnoses individually. Immunologic mechanisms triggering the occurrence of these diagnoses together, are difficult to address. Although the coexistence of thymoma, MG and sarcoidosis may be coincidental, it is noteworthy to report this case because of the multiple interesting features observed as well as the rarity of occurrence.