Presentation
Headache and left sided weakness.
Patient Data
Multiple solid / cystic masses are present surrounded by edema. The masses peripherally enhance.
Multiple partially cystic / solid masses, largest in right temporal lobe causing midbrain shift and uncal herniation are present. The larger lesions are associated with significant cystic change. The lesion in the right lateral temporal lobe has a more inferior solid portion measuring 4.5 centimeters in size and a larger superomedial cystic portion that measures 6.3 x 3.8 cm in size. A separate lesion is seen in the medial right cerebellum is 13 mm m. Mass effect from the right cerebral lesions causes moderate subfalcine herniation to the left and the ventricular trapping.
Existing moderate chronic small vessel ischemic white matter disease is present in both cerebral hemispheres.
The patient went on to have a craniotomy and resection of the larger right sided mass.
Histology
MICROSCOPIC DESCRIPTION:
Paraffin sections show a densely hypercellular tumor. Tumor cells have moderately pleomorphic round and oval nuclei with prominent nucleoli and moderate numbers of mitoses. These are arranged in solid aggregates within a fibrous and vascular stroma. The feature are of metastatic carcinoma and are most consistent with an origin from breast.
DIAGNOSIS:
Metastatic carcinoma with features most consistent with an origin from breast.
Case Discussion
The patient did in fact have a history of breast cancer. This case demonstrates that metastases can have quite a varied appearance, with this one having a large cystic component.
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