Cerebral metastases: colorectal adenocarcinoma

Case contributed by Dr Yune Kwong

Presentation

Dizzyness, light-headedness

Patient Data

Age: 73
Gender: Male

On non-contrast scan, there is high density lesion in the left parieto-occipital region, with marked surrounding vasogenic oedema.

Left parieto-occipital tumour, low signal on T2. The high density on CT does not correspond to calcification or blood products on SWI.

Histology of brain resection:

MACROSCOPIC DESCRIPTION: Multiple  fragments  of  congested  tan  and  tan friable tissue, weighing 13g in total.
MICROSCOPIC DESCRIPTION: Highly necrotic glandular and papillary carcinoma. The necrotic debris  is  rich in degenerate nuclear material and appears to show progressive  accumulation  in gland lumens causing distension and rupture. Certain  necrotic  foci  display  a margin of cribriform glands. The tumour is accompanied by a fibrous  stroma  and is continuous with gliotic brain tissue.
DIAGNOSIS: Adenocarcinoma. The tumour resembles many cases of colonic carcinoma.

Histology of sigmoid tumour biopsy:

MACROSCOPIC: Four fragments of pale tan tissue from 2mm  to  4mm in greatest dimension.
MICROSCOPIC: Inflammatory exudate overlies fibrosis within which  are  seen  pseudostratified columnar epithelium-lined glands and clumps of round and polygonal  cells.   The glandular and solid epithelial structures lack mucin.  This contrasts  with  the bulk of the material which  consists  of  mucus-rich,  deformed  crypts.
DIAGNOSIS: Adenocarcinoma.

Case Discussion

The high signal on the plain CT and low T2 signal was due to mucinous material.

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Case information

rID: 29578
Case created: 6th Jun 2014
Last edited: 22nd Jan 2016
Inclusion in quiz mode: Included

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