Cerebellar metastasis

Case contributed by A.Prof Frank Gaillard

Presentation

Ataxia

Patient Data

Age: 80 years
Gender: Male
Modality: MRI

There is a well defined heterogeneous intra axial mass in the left cerebellar hemisphere. This demonstrates heterogeneous T2 and FLAIR signal - predominantly hyperintense centrally and predominantly hypointense peripherally. Areas of high intrinsic T1 signal centrally and peripheral blooming on susceptibility sensitive sequence suggest the presence of blood products. Abnormal signal on diffusion weighted imaging which is difficult to interpret in the presence of blood products. Heterogeneous enhancement in the mass following contrast administration. Surrounding T2 and FLAIR hyperintensity in the left cerebellar hemisphere extending into the left cerebral peduncle. Minor mass-effect on the left lateral wall of the fourth ventricle but no effacement. Established infarcts in right cerebellar hemisphere.

Periventricular T2 and FLAIR hyperintensity, with multiple foci of T2 FLAIR white matter of both hemispheres and in the pons most in keeping with chronic small vessel ischaemic disease. No other parenchymal abnormality or other region of abnormal enhancement.

Conclusion

Well-defined enhancing mass in the left cerebellar hemisphere with intrinsic T1 hyperintensity and blooming on susceptibility sensitive sequence suggesting haemorrhage. Appearance most likely represents a solitary hemorrhagic metastasis. 

Case Discussion

The patient had a prior history of lung cancer (adenocarcinoma) and went on to have surgery.

HISTOLOGY

MICROSCOPIC DESCRIPTION: The sections show a densely hypercellular tumour. Tumour cells have pleomorphic large vesicular nuclei many with conspicuous nuclei and a variable amount of pale cytoplasm and are arranged in solid aggregates. Frequent mitotic figures are identified and there is extensive tumour necrosis. Tumour is sharply demarcated from adjacent gliotic brain parenchyma. Immunohistochemistry shows positive staining with CK7 and BER-EP4. The tumour cells are TTF-1 and Napsin-A negative.

FINAL DIAGNOSIS: Metastatic undifferentiated non small cell carcinoma with features most consistent with an origin from lung.

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Case Information

rID: 38835
Case created: 6th Aug 2015
Last edited: 15th Feb 2016
Inclusion in quiz mode: Included

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