Metastatic renal cell carcinoma

Case contributed by Dr Bruno Di Muzio

Presentation

Seizure. Previous history of renal cell carcinoma.

Patient Data

Age: 60
Gender: Female

CT Brain

Modality: CT

Selected images of the brain demonstrating a right frontal lobe mass characterised by an spontaneous hyperdense rim with a vivid contrast enhancement and a central hypodense area (necrotic?). This lesion has a local mass effect with vasogenic oedema and mild anterior mediline shift.     

CT Abdomen and pelvis

Modality: CT

Selected images of the abdomen showing an heterogeneous left kidney mass involving the lower pole and the hilum. There are associated mild hydronephrosis and venous congestion on the left gonadal vein. 

MRI Brain

Modality: MRI

There is an irregular thick peripherally enhancing mass within the superior aspect of the middle frontal gyrus of the right frontal lobe with dimensions of 24mm (trans) x 29mm (AP) x 31mm (CC). Intrinsic T1 hyperintensity within this mass is present, which corresponds with signal dropout on EPI consistent with blood product. There is heterogeneous signal on T2 weighted imaging. Extensive oedema is present within the right frontal lobe which effaces the cerebral sulci and has mass effect on the right lateral ventricle frontal horn. The falx cerebri is bowed slightly to the left. Midline shift to the left of 3mm measured at the septum pellucidum. No other abnormal enhancement is present. DWI & T2* perfusion are difficult to interpret in the setting of blood product within the right frontal mass, but there is peripheral increased CBV. Spectroscopy demonstrates a markedly elevated lipid/lactate peak within the non-enhancing centre of the mass, consistent with necrosis. There is reduced NAA and reversed choline: creatine ratio. No hydrocephalus. No acute infarct.

Conclusion: Solitary haemorrhagic right frontal mass is most likely a metastasis in the context of previous renal cell carcinoma. A GBM is less likely. 

Case Discussion

This case was histologically proven to be a RCC metastasis. 

Haemorrhagic intracranial metastases classically originate from: 

  • melanoma
  • renal cell carcinoma
  • choriocarcinoma
  • thyroid carcinoma: papillary carcinoma of thyroid has highest rate of haemorrhage
  • lung carcinoma: given the sheer number of cases, even though atypical for these primaries they are none the less common
  • breast carcinoma: as for lung
  • hepatocellular carcinoma

 

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Case Information

rID: 38785
Case created: 3rd Aug 2015
Last edited: 3rd Apr 2017
Tag: rmh
Inclusion in quiz mode: Included

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