Cerebral metastases - colorectal adenocarcinoma
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Left parieto-occipital tumour, low signal on T2. The high density on CT does not correspond to calcification or blood products on SWI.
The patient went on to have both the brain lesion resected and a sigmoid mass biopsied.
Histology (brain lesion):
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.
FINAL DIAGNOSIS: Adenocarcinoma. The tumour resembles many cases of colonic carcinoma.
Histology (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.
FINAL DIAGNOSIS: Colorectal adenocarcinoma.
The high signal on the plain CT (not shown) and low T2 signal was due to mucinous material.