A rare case report of insular metastatic from sarcoma with successful long term surgical and oncological management

Brain metastases are the most common intracranial tumors in adults, yet they remain rare in sarcoma patients, occurring in <6 % of cases. Metastatic spread of sarcomas typically involves the lungs, bones, and liver, with brain involvement being an unusual and poorly understood occurrence. Given the limited data, management strategies remain challenging, and prognosis is generally poor.

A previously healthy 16-year-old female presented with left shoulder pain and restricted movement. Imaging revealed a pathological fracture of the proximal humerus with a destructive mass lesion, and biopsy confirmed a diagnosis of high-grade sarcoma. She underwent chemotherapy, tumor resection, and later a pneumonectomy for lung metastases. Thirty months post-diagnosis, she developed progressive left-sided weakness, and brain MRI demonstrated a right insular metastatic lesion. She underwent gross total resection via microscopic right pterional craniotomy, followed by whole-brain radiotherapy and rehabilitation. At 42 months post-diagnosis, she remained recurrence-free with stable neurological function.

Brain metastases from sarcomas are rare and associated with poor prognosis. Pulmonary metastases are the strongest risk factor, and survival remains limited despite treatment. Surgical resection improves neurological function and extends survival in select patients with a high Karnofsky Performance Scale score and controlled systemic disease. Stereotactic radiosurgery is an option for multiple lesions, while WBRT and chemotherapy are reserved for widespread disease.

This case highlights the potential for favorable outcomes in sarcoma brain metastases with a multidisciplinary approach. Early detection and tailored intervention may improve survival and quality of life in such patients.