Cerebral metastasis (colorectal)

Case contributed by A.Prof Frank Gaillard

Presentation

Left leg weakness.

Patient Data

Age: 50 years
Modality: MRI

Well defined heterogeneous parafalcine mass in the right paracentral lobule, appears intra-axial and located at the grey-white matter junction. Adjacent high T2/FLAIR signal abnormality extends into pre and post frontal gyri. Heterogeneous enhancement of the mass with regions of susceptibility artefact, no diffusion restriction abnormality. Adjacent cortex is not thickened. No other lesion seen. On perfusion imaging, cerebral blood volume (CBV) is low in the cystic component of the lesion, but mildly increased in the solid component. It is markedly reduced in the non-enhancing high T2 signal white matter. Spectroscopy suggests elevation of choline and reduced NAA over the tumour, but shows a normal trace in the high T2 signal white matter. 

Overall features favour a metastasis. 

Modality: CT

Within the ascending colon, there is a section of circumferential mural thickening within the colon without associated bowel obstruction. Enlarged retroperitoneal lymph nodes. 

Case Discussion

The patient went on to have a resection.

Histology

MICROSCOPIC DESCRIPTION:

Sections of brain tissue show a cohesive tumour composed of mucin-secreting cribriform glands. Tumour cells contain abundant eosinophilic cytoplasm, vesicular nuclei and prominent nucleoli. Frequent mitoses and central necrosis are present.

Immunohistochemical results show tumour cells stain: CK7-, CK20+, TTF1- and CDX2+

FINAL DIAGNOSIS: Metastatic moderately differentiated adenocarcinoma, consistent with colorectal primary.

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Case Information

rID: 50394
Case created: 3rd Jan 2017
Last edited: 6th Apr 2017
Inclusion in quiz mode: Included

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