Presentation
Three month history of confusion and recurrent falls.
Patient Data
Hyperattenuating and enhancing lesion at the mid-section of the falx cerebri with mass effect on the frontal and parietal lobes. Associated edema in these lobes adjacent to the lesion. A second smaller enhancing lesion in the right frontal lobe.
Conclusion: Appearance of both lesions suspicious for meningioma although the falcine lesion is less typical.
There is an enhancing lesion at the mid-section of the falx cerebri with mass effect on the frontal and parietal lobes. Associated edema in these lobes adjacent to the lesion. A second smaller enhancing lesion in the right frontal lobe.
Case Discussion
The patient underwent an excision of the large sagittal lesion.
Histology
The sections show features of metastatic moderately differentiated adenocarcinoma. The tumor forms nests, complex glandular structures and single acini. The glandular lumina contain calcified debris. The tumor cells have enlarged nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. No evidence of lymphovascular invasion is seen.
- positive
- CAM5.2
- AE1/3
- EMA
- CK7
- GCDFP-15
- negative
- TTF-1
- CK20
- CDX-2
- estrogen receptor: negative.
- progesterone receptor: negative.
- HER2: positive. More than 50% of the tumor cells show strong membranous staining.
FINAL DIAGNOSIS: Metastatic moderately differentiated adenocarcinoma consistent with breast cancer primary.
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