Cerebral metastasis

Case contributed by Dr Henry Knipe

Presentation

Presents to ED with confusion and word finding difficulties. External CT - left MCA infarct with oedema.

Patient Data

Age: 75 years
Gender: Male
CT

Extensive vasogenic edema with partial effacement of the left lateral ventricle but no midline shift or cerebral parenchymal herniation. Elsewhere, there is periventricular and deep white matter hypoattenuation, most in keeping with chronic small vessel ischemia. No hydrocephalus. Grey-white differentiation is preserved. No hyperdense vessel. 

CT

In the left parieto-occipital region is a homogeneously and vividly enhancing mass. It has slightly lobulated contours and is isodense to gray matter on the non-contrast images. Extensive surrounding vasogenic edema. 

MRI

Left parietal intra-axial mass involving the cortex and adjacent white matter with isointense signal to the cortex on both T1 and T2, moderate diffusion restriction, and vivid contrast enhancement. No evidence of hemorrhage. Diffuse vasogenic edema with mild effacement of the posterior aspect of the left lateral ventricle.

Multiple high T2/FLAIR signal foci scattered through the supratentorial white matter are nonspecific, most likely represents chronic small vessel ischemia. 

Histopathology:

MACROSCOPIC DESCRIPTION: "Parietal lobe tumour": The specimen consists of a pale tan haemorrhagic nodule 16x10x9mm. The cut surface is heterogeneous with yellow and cream colour. A1.

MICROSCOPIC DESCRIPTION: The sections show features of metastatic poorly differentiated adenocarcinoma. The tumour forms solid nests, some containing occasional glandular lumina. The tumour cells have enlarged pleomorphic nuclei, prominent nucleoli and moderate amounts of pale cytoplasm. No evidence of lymphovascular invasion is seen. The tumour cells are CK7, TTF-1 and Napsin-A positive, in keeping with lung primary.

DIAGNOSIS: Metastatic poorly differentiated adenocarcinoma, in keeping with lung primary.

Case Discussion

CT demonstrates a large lung mass, and lung cancer is one of the most common causes of cerebral metastases. Approximately 50% of cerebral metastasis present as a solitary mass, and this diagnosis should always be thought of in patients with cerebral masses, especially in older patients. 

PlayAdd to Share

Case information

rID: 46744
Published: 15th Jul 2016
Last edited: 4th Feb 2019
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.