Isolated brain metastases as the sole manifestation of a late relapse in breast cancer

We report on a 62-year-old female patient suffering from breast cancer (invasive ductal, premenopausal, estrogen- and progesterone-receptor status unknown) first diagnosed in July 1991. After mastectomy and axillary lymphonodectomy (pT2 N2 (12/15) M0 G2), adjuvant chemotherapy consisting of six courses epirubicin and cyclophosphamide was performed. Since 1993, serum Ca 15-3 levels began to climb slowly. As of June 1996, Ca 15-3 was measured 50.1 U/ml (normal value <28.0 U/ml). In routine follow-ups, Ca 15-3 increased slowly, but no metastases of the breast cancer could be detected. In September 2000, the patient attended a routine follow-up examination with poor performance status, presenting with ataxia and a psychic syndrome. Computed tomography revealed multiple suprasellar brain metastases. We conclude that this is an unusual case of a very late clinical manifestation of sole brain metastases in a patient with breast cancer. A slow preceding increase of Ca 15-3-level over a period of 7 years was the only indicator of the upcoming brain metastases.