Skull metastasis from lung

Case contributed by A.Prof Frank Gaillard

Presentation

Lump on head.

Patient Data

Age: 65 years
Gender: Male
CT

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

 

MRI

 

Pre and post IV contrast multiplanar imaging of the brain has been performed. There is a large mass centered within the anterior left frontal bone. This is a destructive mass with a small amount of tumor 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 hemorrhage identified. No signal abnormality evident. No restricted diffusion.

Conclusion: 

Mass most likely represents a metastasis. Meningioma and hemangiopericytoma 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 tumor involving brain parenchyma. Tumor 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 tumor necrosis. Immunohistochemistry shows strong cytoplasmic staining in tumor 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 tumor cells. 

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

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Case information

rID: 43303
Published: 13th Apr 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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