A RARE CASE OF MULTIPLE CYSTIC METASTASES IN THE BRAIN FROM ADENOCARCINOMA OF THE LUNG - PowerPoint Presentation

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A RARE CASE OF MULTIPLE CYSTIC METASTASES IN THE BRAIN FROM ADENOCARCINOMA OF THE LUNG

A. HRICHI, S. KOUKI, M. LANDOULSI ,R. AOUINI,  I. GANZOUI, S.BOUGUERRA, Y. AROUS, H. BOUJEMAA, N. BEN ABDALLAHRadiology service, Main Military hospital of Instruction of Tunis, Tunisia

CH7

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Inroduction

:

Several

diseases

can present with multi-cystic brain lesions:

True cysts

Abscess formations

Cysticercosis

Fungal infections

Cerebral tumors

Metastases…

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Radiologist

role

?

1- Positive

diagnosis

easy! 2- Approach of etiologic diagnosis: the main question!

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Case report:

A rare case of cystic

intracerebral

metastases from

adenocarcinoma

of the lung

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♂

49 years oldNo medical histories

Smoking patient

Presented with progressive dizziness and equilibrium disorders that had developed for 5 days.

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Neurological examination:cerebellar

syndrome

no other focal signs

Biology:

Lymphocytes:  ↓

Alkaline phosphatase: ↑Other laboratory studies: normal CT brain Scan was indicated

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CT brain scan without(a) and with(b) injection of iodinated contrast: multifocal hypodense lesions(a) with partial peripheral contrast enhancement(b) but without significant

perifocal

oedema

.

Imaging findings: a1 b1

a2 b2

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Further brain MRI was performed and allowed

to

objectify

:

multifocal cystic lesions with partial peripheral contrast enhancement but without significant perifocal oedema.

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Axial T1-weighted with (a1, a2, a3) and without gadolinium (b1, b2, b3):

nodular

hypointense

multiple extra-axial

lesions

,

with partial peripheral contrast enhancement.a1 a2 a3b1 b2 b3

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Axial T2-

weighted (a1, a2, a3) and FLAIR (b1, b2, b3): Multiple hyper-T2 hypo-FLAIR extra-axial lesions

(

cystic

lesions

).

a1 a2 a3

b1 b2 b3

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axial diffusion (a1, a2, a3) and ADC (b1, b2, b3):Multiples nodular

lesions

hyperin

tense in diffusion with a low ADC.

a1 a2 a3

b1 b2 b3

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In total:

♂49 years old

No

medical

histories

Smoking patient

Lc ↓ , PAL ↑multi-cystic brain lesions (CT – MRI) ????

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In total:

♂49 years old

No

medical

histories

Smoking

patientLc ↓ , PAL ↑multi-cystic brain lesions (CT – MRI) ???

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In total:

♂49 years

old

No

medical

histories

Smoking patientLc ↓ , PAL ↑multi-cystic brain lesions (CT – MRI) ??

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In total:

♂49

years

old

No

medical historiesSmoking patientLc ↓ , PAL ↑multi-cystic brain lesions (CT – MRI) ?

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Lung cancer?

In total:

♂

49

years

oldNo medical historiesSmoking patientLc ↓ , PAL ↑multi-cystic brain lesions (CT – MRI)

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a CT-chest-scan revealed a

lungular small nodule not exceeding 12mm of main line with no other secondary locationsStereotaxic brain biopsy confirmed

a well-differentiated

lung

adenocarcinoma

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Discussion:

Brain lesions in patients with known malignancies are suspicious for metastases; → usually: as well-circumscribed densely enhancing masses with surrounding

vasogenic

edema.

Cystic brain lesions are unusual;

→ can be misdiagnosed as: brain abscesses, primary cerebral tumors, or parasitic infections, especially in patients without a history of malignancy.

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Cystic cerebral metastases have been described in carcinomas of :

ThymusBreastProstatePancreas

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However, and in reviewing the literature:

-We have only found 2 similar cases reports of lung adenocarcinoma with cystic cerebral metastases.

-In both of them, the patients were already followed for bronchial

adenocarcinoma

.

- while in our case, cystic cerebral metastases

revealed the disease.

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Conclusion:

This case demonstrates an unusual pattern of cerebral metastases of a bronchial adenocarcinoma. This constellation should be considered in the differential diagnosis of cerebral cystic lesions even in patients without a history of malignancy, and

wich

is necessary to evoke at every smoking adult's of about forty. The exact nature of which might be difficult to assess without biopsy.

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Kamkarpour

 A.

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