Cerebral metastasis with calvarium and extracranial invasion

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of mastectomy due a breast carcinoma one year ago.

Patient Data

Age: 67
Gender: Female

CT images showing a large nodular hyperattenuating mass located in the right temporal lobe, associated with an extensive surrounding vasogenic oedema and invading the adjacent bone reaching the subgaleal space. 

MRI Brain

Modality: MRI

Enhancing lesion in the right temporal lobe measures 33 x 35 mm in axial dimensions. There is a small focal area of intrinsic high T1 signal in the periphery with corresponding low T2 signal and susceptibility artefact within the lesion in keeping with a small area of blood products.

The lesion also involves the adjacent calvarium and has a moderate-sized extracranial component. There is no convincing diffusion restriction. Multi voxel spectroscopy (not shown here) is largely non-contributory, it is not compatible with a glial series tumour. Perfusion imaging (not shown here) demonstrates increased cerebral blood through the periphery of the lesion with reduced blood flow within the centre of the lesion. There is mild adjacent dural thickening and enhancement.

There is a second nodular area of enhancement at the posterior aspect of the right porous acoustic is, measuring 4 x 6 mm.

Adjacent high FLAIR signal extends through the temporal lobe into the parietal lobe and basal ganglia. There is mass effect on the right lateral ventricle with 4 mm of midline shift to left measured at the 3rd ventricle. No extra-axial collection.

The osseous calvarium has diffusely low, mildly mottled marrow signal.

CONCLUSION:

Large right temporal lesion with calvarium and extracranial component and a second smaller right CP angle enhancing nodule most likely represents metastatic disease. Possible diffuse calvarial metastases.

Case Discussion

Based on the clinical history and imaging features of these lesions the diagnosis of metastatic disease was proposed. There is no pathological confirmation. 

 

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Case Information

rID: 37600
Case created: 15th Jun 2015
Last edited: 10th Sep 2015
Tag: rmh
Inclusion in quiz mode: Included

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