Cerebral metastasis - colorectal adenocarcinoma

Case contributed by Frank Gaillard
Diagnosis certain


Left leg weakness.

Patient Data

Age: 50 years

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 tumor, but shows a normal trace in the high T2 signal white matter. 

Overall features favor a metastasis. 

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.



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

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

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

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