Brain metastases from squamocellular lung cancer

Case contributed by Dr Nikola Todorovic

Presentation

Haemoptysis. Breathing difficulties. 30 years history of smoking 20 cigarettes/day.

Patient Data

Age: 60 years
Gender: Male

There is a large mass overlaying left hilum, with the decreased transparency of the left lung, and shifting of the trachea to the left.

Resultant left upper lobe collapse.

A large mass in the left hilum, around 4 cm in size with central necrosis infiltrating left upper lobe bronchus and left pulmonary artery. There is a subatelectasis of the left upper lobe.

Mediastinal lymphadenopathy.

Bilaterally enlarged adrenal glands, more pronounced on the left.

Abdominal artery aneurysm with maximal diameter around 4 cm.

MRI

A year later

There are multiple diffuse expansive lesions in the cerebrum and cerebellum, iso to hyperintense on T2 and FLAIR, hypointense on T1W, with perilesional edema and pronounced, in most lesions, rim SI enhancement which is consistent with metastases.

Case Discussion

The patient with 30 years history of smoking presented with haemoptysis and difficulties breathing. Chest radiography and CT was performed and revealed a large left hilar mass. 

Laboratory-sedimentation rate-90, CRP-38. Other parameters were in the reference range.

Bronchoscopy confirmed the presence of infiltration of the left upper bronchus. The biopsy was performed and the result was moderately differentiated squamocellular carcinoma.

The patient was treated with chemotherapy (EP-2), but the follow-up CT scan (not shown),  revealed the mild progression of the disease.

The oncologist then decided to use radiotherapy and 20 radio sessions were performed. The patient complained of vertigo, nausea and vomiting (up to 3/day).

MRI brain was performed and revealed multiple brain metastases.

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Case information

rID: 56515
Case created: 6th Nov 2017
Last edited: 9th Nov 2017
Inclusion in quiz mode: Included

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