Brain metastases from renal cell carcinoma

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Known left renal malignancy. Persistent headach and attacks of convulsions

Patient Data

Age: 60-65
Gender: Male
CT

CT abdomen done to search for the primary

Known patient with history of left renal malignancy with no operative intervention performed;

Left exophytic renal soft tissue mass lesion is noted at the lower pole measuring about 6.4 , 6.4 and 5.4  cm in AP, SS and CC dimension. It is seen Invading the lower calyceal system with stranding of the surrounding and abutting the left psoas muscle with no line of cleavage.

This is associated with a rather well defined cortical focal soft tissue lesion at the upper left kidney measuring about 10 x 10 mm. anther Two a rather well defined cortical focal soft tissue lesion at the upper and lower zone of the right kidney measuring about 14 x 14 mm and 12 x 12 mm respectively .

Bulky left supra renal gland with heterogeneously enhancing soft tissue lesion of the right supra renal gland measuring 21 x 13 mm  with attenuation density more than 15 HU in non contrast study

MRI

MRI brain of the same patient with the above described renal malignancy

Multiple metastatic lesions noted involving both cerebral hemispheres, notably the left frontal and right temporal lobes  & at the left cerebellar hemisphere. They show enhancing soft tissue and degenerated & cystic components. The largest lesion is noted at the right temporal lobe measuring about 3 x 2.7 x 3 cm in size. Mild peri-lesional edema noted. No mid-line shift detected.

 

Case Discussion

Cerebral metastasis is common and is suspected in patients with primary malignancies with neurological manifestations. Renal cell carcinoma is one of the commonest primaries of brain metastasis.

Cerebral metastasis are usually solid, however it can show cystic changes as a tumor associated cysts or due to necrosis, also it can be predominately cystic with marginal enhancing solid component. Brain metastasis can show hemorrhagic changes especially at their cystic component. Other common primaries include; lung cancer, breast cancer, Colo-rectal carcinoma and melanoma.

Half of brain metastasis are solitary, and history of primary malignancy aids in suggesting metastasis rather than primary tumor, especially if associated with other sites of metastasis. As solitary metastasis can entirely appear in MRI like primary intra-cranial tumor .... as it reflects different management and prognosis.

MRI is more sensitive than CT in detecting brain metastasis.

 

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Case information

rID: 42222
Case created: 11th Jan 2016
Last edited: 29th Jun 2017
Inclusion in quiz mode: Included

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