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**''Lung'' followed by ''kidney'' is the order in a smaller series.<ref>{{Cite journal | last1 = Schouten | first1 = LJ. | last2 = Rutten | first2 = J. | last3 = Huveneers | first3 = HA. | last4 = Twijnstra | first4 = A. | title = Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colo...
*Treatment: Surgery 1-3 metastases, Stereotactic RT in 1-4(rarely up to 10) metastases, >4-10 metastases: Whole Brain RT.
==Gross/Radiology==
*Intra-axial location.
**Typically at the grey-white junction.<ref name=pmid19727563>{{Cite journal | last1 = Della Puppa | first1 = A. | last2 = Dal Pos | first2 = S. | last3 = Zovato | first3 = S. | last4 = Orvieto | first4 = E. | last5 = Ciccarino | first5 = P. | last6 = Manara | first6 = R. | last7 = Zustovich | first7 = F. | last8 = Be...
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656562/figure/F1/ Brain metastases (nih.gov)].<ref name=pmid23717796 >{{Cite journal | last1 = Pekmezci | first1 = M. | last2 = Perry | first2 = A. | title = Neuropathology of brain metastases. | journal = Surg Neurol Int | volume = 4 | issue = Suppl 4 | pages = S245-55 |...
<gallery>
File:AFIP403613G-THYROID PAPILLARY CARCINOMA METASTATIC TO BRAIN.jpg | Well demarcated metastasis (WC/Dr. Kostich)
File:BrainMetastasisFromBreastCancer.jpg | 3 brain metastases in breast cancer (WC/Jmarchn)
</gallery>
==Microscopic==
Appearance varies by subtype.
Features of [[metastatic carcinoma]]:
*Tubule formation/glands.
*Usually well-circumscribed/sharply demarcated from surrounding tissue.
*Usually nuclear atypia including:
**Nuclear hyperchromasia.
**Variation of nuclear size.
**Variation of nuclear shape.
*Mitoses - common.
DDx:
*Primary brain tumour - ''see [[Neuropathology_tumours#Primary_versus_secondary|primary brain tumour versus secondary brain tumour]]''.
===Images===
<gallery>
Image:Metastatic_adenocarcinoma_-_cerebellum_-_very_low_mag.jpg | [[CRC]] metastasis to cerebellum - very low mag. (WC)
Image:Metastatic adenocarcinoma - cerebellum - intermed mag.jpg| CRC metastasis to the cerebellum - intermed. mag. (WC)
Image:Metastatic_adenocarcinoma_-_cerebellum_-_high_mag.jpg | CRC metastasis to cerebellum - high mag. (WC)
Image:Brain metastasis - high mag.jpg | Brain metastasis - high mag. (WC)
File:Adenocarcinoma infiltrating the brain.jpg | Adenocarcinoma of the lung metastasis. (WC/jensflorian)
</gallery>
==IHC==
{{Main|Immunohistochemistry}}
*Carcinoma: pankeratin +ve.
**[[Lung adenocarcinoma]] and SCLC: TTF-1 +ve, CK7 +ve, CK20 -ve.
**Breast carcinoma: CK7 +ve, ER +ve, PR +ve, BRST2 +ve/-ve.
**Colorectal carcinoma: CK7 -ve, CK20 +ve, CDX2 +ve, TTF-1 -ve.
**[[Clear cell renal cell carcinoma]]: PAX8 +ve, CK7 -ve, CK20 -ve, vimentin +ve, CD10 +ve.
*Melanoma: S-100 +ve, HMB-45 +ve, Melan A +ve.
*GFAP -ve.<ref name=pmid23717796 >{{Cite journal | last1 = Pekmezci | first1 = M. | last2 = Perry | first2 = A. | title = Neuropathology of brain metastases. | journal = Surg Neurol Int | volume = 4 | issue = Suppl 4 | pages = S245-55 | month = | year = 2013 | doi = 10.4103/2152-7806.111302 | PMID = 23717796 }}</ref>
Other glial markers (suggest primary):<ref name=pmid23717796/>
*OLIG2, SOX2.
<gallery>
File:Immunhistochemie Bronchialkarzinom.jpg | CK7+/CK20-/TTF1+ profile in pulmonary adenocarcinoma metastasis. (WC/Marvin101)
</gallery>
==Origin==
===Breast===
*8-30% BM.
*Triple-negative cases have a poor prognosis.
==See also==
*[[Neuropathology tumours]].
*[[Metastasis]].
==References==
{{Reflist|2}}
[[Category:Neuropathology]]
[[Category:Diagnosis]]
668c1a825ba0ff55fc7b9d7d91e779e32ec00b8ca7c0ed9500b0d648e183a07d librepath-brain-metastasis.txt
[[Image:Diagram showing the lobes and ducts of a breast CRUK 307.svg|thumb|250px|Diagram of the structure of breast. (CRUK/WC)]]
The '''breast''' is an important organ that [[pathologist]]s see quite often because it is often afflicted by [[breast cancer|cancer]]. Before women started [[smoking]] in large numbers, it was a leading cause of cancer death in women.
Fortunately, breast cancer, in this day, has a relatively good prognosis if it is detected early.
=Clinical=
===Clinical Presentations of Breast Pathology===
*'''Abnormal/suspicious screening mammogram'''
**Suspicious microcalcifications and/or suspicious mass.
**Most common history on the specimen requisition
**May be accompanied by a [[BI-RADS]] score.
*Nipple discharge.
*Pain.
*Breast lump/mass.
*New nipple inversion.
*Skin changes, e.g. ''peau d'orange''.
===Breast cancer screening===
Breast cancer screening, for normal risk individuals, starts at age 50 in Canada. In the USA, breast screening starts at age 40.
Radiologic screening is less effective in younger individual as:
# The breast is more dense and thus radiologically more difficult to interpret, and
# The incidence of breast cancer is lower.
===Breast radiology===
{{Main|Breast imaging reporting and data system}}
=Specimens=
Three major specimen types:
#Core needle biopsy (CNB).