Metastatic adenocarcinoma of the colon

Case contributed by Dr Hani Salam

Presentation

This is a 70-year-old male patient presented with history of confusion and altered mental status of early onset.

Patient Data

Age: 70 years
Modality: CT

CT brain was performed at the on-call time to rule out stroke. NCCT revealed a relatively hyperdense lesion at the left occipital lobe with necrotic center and significant surrounding vasogenic edema. CECT demonstrate avid peripheral, thick enhancement. The mass is exerting a mass effect, effacing the ipsilateral sulci and posterior horn of left lateral ventricle. 

CECT of the abdomen revealed a circumferential focal thickening of the cecal wall, with minimal surrounding stranding. No focal liver lesion. 

Modality: MRI

MRI revealed left occipital well defined lesion, it elicits isointense signal at T1 & high signal at T2 WI, showing thick enhancing margins and necrotic center, with no evidence of diffusion restriction, the lesion is surrounded by perifocal edema signal and exerts positive mass effect in the form of compression of the trigone of the left lateral ventricle. 

Case Discussion

This was somehow tricky lesion. Is it a metastatic lesion or primary brain tumor?. Being single lesion without the patient being known to have primary made metastasis somehow unlikely.

CEA was positive in this case. Abdomen CT was performed to rule out primary GI malignancy. CECT of the abdomen revealed a cecal mass, which was proven to be adenocarcinoma. Being single lesion, resection was conducted which confirm the diagnosis of metastatic adenocarcinoma.

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Case Information

rID: 8581
Case created: 14th Feb 2010
Last edited: 28th Nov 2015
Inclusion in quiz mode: Included

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