Multiple Cystic Metastases in the Brain from Adenocarcinoma of the Lung
Article Outline
To the Editor:
Several diseases, such as true cysts, abscess formations, cysticercosis, fungal infections, and cerebral tumors can present with cystic brain lesions.1, 2, 3, 4
Here we present a case of cystic intracerebral metastases in a patient with adenocarcinoma of the lung.
Case Report
A 66-year-old woman presented with progressive sleepiness and disorientation that had developed for 3 months. Two years prior, an inoperable non-small-cell lung cancer with intrapulmonal metastases was diagnosed, irradiated repeatedly, and treated palliatively with chemotherapy. The neurological examination showed speech impairment, motor apraxia, and slightly exaggerated muscle tendon reflexes on the left side, but no other focal signs. Lymphocytes were diminished, alkaline phosphatase and gamma glutamyl transpeptidase were increased; other laboratory studies were normal.
Magnetic resonance imaging of the brain revealed multifocal cystic lesions with partial peripheral contrast enhancement but without significant perifocal edema (Figure 1). Stereotaxic brain biopsy confirmed a low differentiated lung adenocarcinoma (Figure 2).
Figure 1.
T2-weighted magnetic resonance (MR) image with fat saturation demonstrating multiple cystic brain lesions (A); T2-weighted MR image with fluid-attenuated inversion recovery showing multiple hyperintense cystic lesions without brain edema (B); T1-weighted axial MR image before (C) and after venous gadolinium administration (D) showing multiple cystic lesions with partial peripheral contrast enhancement.
Figure 2.
Histopathology confirmed metastases of lung adenocarcinoma (hematoxylin-eosin staining).
Discussion
Brain lesions in patients with known malignancies are suspicious for metastases. Usually, these present as well-circumscribed, densely enhancing masses with surrounding vasogenic edema. In contrast, cystic lesions are unusual and can, therefore, be misdiagnosed as brain abscesses, primary cerebral tumors, or parasitic infections, especially in patients without a history of malignancy.1, 2, 3
Otherwise, nonmetastatic cerebral cystic lesions can be mistaken for metastases in patients with known tumors.5
Cystic metastases have been described in carcinomas of the thymus, breast, prostate, and pancreas.1, 6, 7, 8 In reviewing the literature, we found only 1 similar case report of lung adenocarcinoma with cystic cerebral metastases.8
Conclusion
Our case demonstrates an unusual pattern of cerebral metastases in a patient with bronchial carcinoma. This constellation should be considered in the differential diagnosis of cerebral cystic lesions, the exact nature of which might be difficult to assess without biopsy.
References
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- Brain metastases in renal cell cancer: diagnostic and therapeutic aspects. Am J Clin Oncol. 2004;27:632–634
- Multiple brain metastases from malignant thymoma. J Clin Neurosci. 2007;14:1116–1120
- Cystic prostate metastases to the brain parenchyma: report of two cases and review of the literature. J Neurooncol. 2001;51:167–173
- . Lung carcinoma presenting as multiple cystic lesions in the brain. Del Med J. 1998;70:77–80
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data.
PII: S0002-9343(09)00498-7
doi:10.1016/j.amjmed.2009.02.030
© 2009 Elsevier Inc. All rights reserved.
