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

Inroduction:

Several diseases can present with multi-cystic brain lesions:

True cysts Abscess formations Cysticercosis Fungal infections Cerebral tumors Metastases…

Radiologist role?

1- Positive diagnosis

easy!

2- Approach of etiologic diagnosis:

the main question!

Case report:

A rare case of cystic intracerebral metastases from adenocarcinoma of the lung

♂ 49 years old No medical histories Smoking patient Presented with progressive dizziness

and equilibrium disorders that had developed for 5 days.

Neurological examination: cerebellar syndrome no other focal signsBiology: Lymphocytes: ↓ Alkaline phosphatase: ↑ Other laboratory studies: normal

CT brain Scan was indicated

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

Further brain MRI was performed and allowed to objectify:

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

Cliquez sur l'icône pour ajouter une imageAxial 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 a3

b1 b2 b3

Cliquez sur l'icône pour ajouter une imageAxial 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

Cliquez sur l'icône pour ajouter une image 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

In total: ♂ 49 years old No medical histories Smoking patient Lc ↓ , PAL ↑ multi-cystic brain lesions (CT – MRI) ????

In total: ♂ 49 years old No medical histories Smoking patient Lc ↓ , PAL ↑ multi-cystic brain lesions (CT – MRI) ???

In total: ♂ 49 years old No medical histories Smoking patient Lc ↓ , PAL ↑ multi-cystic brain lesions (CT – MRI) ??

In total: ♂ 49 years old No medical histories Smoking patient Lc ↓ , PAL ↑ multi-cystic brain lesions (CT – MRI) ?

Lung cancer?

In total: ♂ 49 years old No medical histories Smoking patient Lc ↓ , PAL ↑ multi-cystic brain lesions (CT – MRI)

a CT-chest-scan revealed a lungular small nodule not exceeding 12mm of main line with no other secondary locations

Stereotaxic brain biopsy confirmed a well-differentiated lung adenocarcinoma

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.

Cystic cerebral metastases have been described in carcinomas of :

Thymus Breast Prostate Pancreas

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.

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.

Check the

lungs

Cystic cerebral lesions

♂

smokingNo

medical histories

Age: about forty

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