Presentation
First episode of convulsion. Cerebral mass visualized on CT scan (not shown).
Patient Data
MRI images show a 5.0 cm peripherally mass in the right frontal lobe extending to the overlying dura, with a cystic central component and a hemorrhagic peripheral rim that demonstrate a pattern of ring enhancement after contrast administration. There is an important mass effect with vasogenic edema associated, but no significant midline shift.
MICROSCOPIC DESCRIPTION: Paraffin sections show fragments of fibrovascular tissue in which there is extensive necrosis and infiltration by a densely hypercellular tumor. Tumor cells have pleomorphic angulated hyperchromatic nuclei and a small amount of cytoplasm and are arranged in small solid polygonal and single-file aggregates within a dense fibrous stroma. Moderate numbers of mitotic figures are noted. Tumor cells form cuffs around small caliber arteries and veins. Several of these show complete lumenal obliteration by endarteritis.
Immunohistochemistry shows strong cytoplasmic staining in tumor cells for cytokeratin CK7 and weaker staining for cytokeratin CK5&6. No staining for TTF-1, E-cadherin, estrogen receptor (ER), progesterone receptor (PgR), HER-2 or GCDFP is seen. The features are of metastatic non-small cell carcinoma most consistent with an origin from lung.
DIAGNOSIS: Brain tissue: Metastatic non-small cell carcinoma with features most consistent with an origin from lung.
Case Discussion
80% of brain metastases can be accounted for by five primary tumors 1:
- lung cancer
- renal cell carcinoma
- breast cancer
- melanoma
- gastrointestinal tract adenocarcinomas (the majority colorectal carcinoma)
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