Presentation
Know history of colorectal adenocarcinoma. Presenting with seizure.
Patient Data
CT Chest showing multiple lung nodules in different size, some of them cavitating, and the large one characterizing masses and demonstrating small calcifications foci. The aspects are in keeping with metastatic disease.
MRI Brain showing nodular lesions in the right frontal and left occipital lobes with heterogenous contrast enhancement. Both cause local mass effect with vasogenic edema. They are pheripherally located and its difficult to say if they are intra or extra-cortical.
Case Discussion
This case represents an atypical metastatic spread of a colorectal adenocarcinoma: sparing the liver, with pulmonary cavitating lesions, calcified lesions and brain metastases.
Calcifying metastases are also rare, but they are described in colorectal carcinomas.
This patient underwent surgery to remove the occipital lesion and it was confirmed as an adenocarcinoma metastasis. The lung lesions were not biopsied.
Another differential to entertain in this pattern and appearances of metastases is a primary ovarian malignancy, which was ruled out.