Cystic brain metastasis from renal cell carcinoma

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Persistent headache not responding to analgesics.

Patient Data

Age: 60
Gender: Male

large intra-axial predominately cystic lesion at the right fronto-parietal region with peripheral solid component. It showed ring enhancement as well as the peripheral solid component. The cystic component follow CSF signal at all pulse sequences with free diffusion. It is surrounded by minimal perifocal edema. It exerts mass effect in the form of effecement of the related sulci, compression of the related frontal horn and body of the right lateral ventricle and midline shift. 

Two small ring enhancing lesions are noted also at the right occipital lobe.

CT

Multiphasic kidney protocol

Large heterogeneous solid mass involving the lower pole of the right kidney with central necrotic changes . It is measuring 15.8 x 14.8 x 18.3 cm at maximum AP, TS and cranio-caudal dimensions with lobulated outline. It is highly vascular with dilated related mesenteric vessels and neoangiogenesis with central necrosis . It showed heterogeneous enhancement at arterial phase with washout at delayed phases. It showed metastatic  lymph node at the right renal hilum.

Case Discussion

Cerebral metastasis is common and is suspected in known patients with primary malignancies with neurological manifestations. Renal cell carcinoma is one of the commonest primaries of brain metastasis.

Cystic appearance of brain metastasis is due to tumor associated cysts, necrosis and it can be predominantly cystic with marginal enhancing solid component as shown in this case. Other common primaries include: lung cancer, breast cancer, colorectal carcinoma and melanoma.

This patient is known of right renal neoplastic lesion with regional nodal, adrenal and lung metastasis.The right renal mass proved to be renal cell carcinoma. and so, brain metastases are the most likely diagnosis.

PlayAdd to Share

Case information

rID: 42145
Case created: 7th Jan 2016
Last edited: 17th Mar 2016
Inclusion in quiz mode: Excluded

Updating… Please wait.
Loadinganimation

Alert accept

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

Alert accept Thank you for updating your details.