Breast Cancer Metastasis to the Cerebellum: A Rare Event in Our Setting, the Adverse Impact of Late Presentation-Case Report

Abstract

Although breast cancer is the commonest cancer in Nigerian women (just as it is worldwide), metastasis to the cerebral parenchyma is very rare and spread to the cerebellum has not been reported. Of more than 37 childhood and adult cerebellar cancers managed in this center (which serves six adjoining states in Nigeria) over 17 years, this case constitutes the first to have arisen from a breast cancer. The 33- year-old woman developed a breast lump for which she did not consult a physician for 2 years. Following a simple mastectomy, she had a six-month course of Adriamycin based adjuvant chemotherapy. The histology was an invasive ductal carcinoma. Eight months after surgery, she noted a gait ataxia but could not consult her physician for review and investigation till another six months because of financial constraint. A delayed cranial CT revealed a solitary cerebellar tumour with obstructive hydrocephalus for which surgery was counselled. Again, she declined a sub-occipital craniectomy opting for an alternative spiritual healing for another six months during which she became blind, deaf, and moribund with a Karnofsky Performance Score of 40. At this point she submitted to the option of CSF diversion followed by tumour excision but died 40 days after -definitive surgery. Histology confirmed features of invasive ductal carcinoma. This report illustrates the rarity of cerebellar metastasis from breast cancer in our environment and the adverse impact on outcome of late presentation, finance and faulty religious belief.