Cerebral metastases

Case contributed by A.Prof Frank Gaillard

Presentation

Seizure.

Patient Data

Age: 75 years
Gender: Female
MRI

Innumerable rim enhancing lesions are demonstrated throughout the supratentorial and infratentorial brain. These lesions are predominantly centred at the grey-white matter junction although there is a deposit in the body of the left lateral ventricle. The largest lesion is in the parafalcine left parietal lobe with moderate surrounding T2 hyperintensity suggestive of reactive oedema. 

No central diffusion restriction is demonstrated. Mildly increased DWI signal at the enhancing component of the some of the larger lesions may reflect high cellularity. Mild compression of the trigone of the left lateral ventricle. Ventricles and sulci are otherwise commensurate the patient's age.

Conclusion: 

Innumerable rim enhancing lesions without central diffusion restriction are compatible with metastases. 

X-ray

There is a left hilar lung mass with at least partial collapse of the left upper lobe. Apparent widening of the mediastinum may partly be due to the collapsed upper lobe or due to left sided mediastinal lymphadenopathy. Small ill-defined nodules bilaterally are likely to represent pulmonary metastases.

CT

There is a solid left upper lobe lesion noted. Large left hilar lymph node. There are innumerable further pulmonary lesions noted, consistent with metastatic disease.

No solid liver lesions are identified. Adrenals are normal. 

Conclusion: Left upper lobe pulmonary mass. Enlarged left hilar node and extensive metastatic disease. 

Case Discussion

The patient went on to have a biopsy of the left upper lobe mass. 

Histology

MICROSCOPIC DESCRIPTION: Sections show fibrous connective tissue infiltrated by nests and single tumour cells containing abundant pale cytoplasm, irregular polygonal nuclei with smooth chromatin and small nucleoli. No definite glandular or squamous differentiation is seen. No pigment is identified.

In immunohistochemical stains, the cells are CK7+, CK20-, p63-, CK5/6+ (weak), TTF-1+, napsin-A+,
CD56-, synaptophysin-, chromogranin-, ER-, GCDFP-.

DIAGNOSIS: Left upper lobe poorly differentiated adenocarcinoma of the lung.

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Case information

rID: 33041
Case created: 28th Dec 2014
Last edited: 12th Sep 2016
Inclusion in quiz mode: Included

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