Skull metastasis from lung

Case contributed by A.Prof Frank Gaillard

Presentation

Lump on head.

Patient Data

Age: 65 years
Gender: Male
Modality: CT

Destructive soft tissue mass involves the frontal bone on the left. 

 

Modality: MRI

 

Pre and post IV contrast multiplanar imaging of the brain has been performed. There is a large mass centred within the anterior left frontal bone. This is a destructive mass with a small amount of tumour extending into the extra-axial space with associated local mass-effect. There is lifting of the underlying dura which demonstrates smooth contrast enhancement beyond this. There is a much larger subcutaneous component of the mass lesion. No other bony lesions identified. No intra or extraaxial haemorrhage identified. No signal abnormality evident. No restricted diffusion.

Conclusion: 

Mass most likely represents a metastasis. Meningioma and haemangiopericytoma are differential diagnoses, but less likely. 

Case Discussion

The patient had a history of prior lung malignancy, and went on to have skull surgery. 

Histology

MICROSCOPIC DESCRIPTION: Paraffin sections show a densely hypercellular epithelial tumour involving brain parenchyma. Tumour cells have large round and oval vesicular nuclei, many with conspicuous nucleoli and a variable amount of pale cytoplasm. These are arranged in solid sheets in a vascular stroma. Frequent mitotic figures are identified and there are multiple foci of tumour necrosis. Immunohistochemistry shows strong cytoplasmic staining in tumour cells for pancytokeratin AE1/AE3, cytokeratins CAM5.2 and CK7 and for carcinoembryonic antigen (CEA) and BerEp4. There is also strong nuclear staining for p40 and p63. No staining for TTF-1, Napsin A or tyrosinase is seen in tumour cells. 

FINAL DIAGNOSIS:  Metastatic undifferentiated non-small cell carcinoma with features favouring poorly differentiated squamous cell carcinoma and most consistent with an origin from lung.

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Case Information

rID: 43303
Case created: 4th Mar 2016
Last edited: 6th Apr 2017
Inclusion in quiz mode: Included

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