Cystic brain metastasis from renal cell carcinoma

Case contributed by Dr Mostafa El-Feky

Presentation

Persistent headache not responding to analgesics.

Patient Data

Age: 60 years
Gender: Male

A large intra-axial predominately cystic lesion at the right frontoparietal region with peripheral solid component. It showed ring enhancement as well as the peripheral solid component. The cystic component follows CSF signal at all pulse sequences with free diffusion. It is surrounded by minimal perifocal edema. It exerts a mass effect in the form of effacement 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.

Multiphasic kidney protocol

CT

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 venous and delayed phases. It showed metastatic lymph node at the right renal hilum.

Case Discussion

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

The 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.

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