Brain metastases from renal cell carcinoma

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Known left renal malignancy.Persistent headaches and attacks of convulsions.

Patient Data

Age: 60 years
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, 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. Another 2 rather well defined cortical focal soft tissue lesion at the upper and lower zone of the right kidney are also noted. 

Bulky left suprarenal gland with heterogeneously enhancing soft tissue lesion of the right suprarenal gland measuring 21 x 13 mm with attenuation density more than 15 HU in the 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 in the right temporal lobe. Mild peri-lesional oedema 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 metastases are usually solid, however, it can show cystic changes as tumour-associated cysts or due to necrosis, also it can be predominately cystic with a marginal enhancing solid component. Brain metastasis can show hemorrhagic changes, especially at their cystic component. Other common primaries include; lung cancer, breast cancer, colorectal carcinoma and melanoma.

About 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, especially in contrast-enhanced T1 WI.

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Case information

rID: 42222
Case created: 11th Jan 2016
Last edited: 12th Nov 2017
Inclusion in quiz mode: Included

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