Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation

Iguchi, Yohei; Mano, Kazuo; Goto, Yoji; Nakano, T; Nomura, Fumio; Shimokata, Tomoya; Iwamizu-Watanabe, Sachiko; Hashizume, Yoshio

doi:10.1007/s00234-006-0152-6

Cited by 35 publications

(39 citation statements)

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“…In previous cases, convulsion [1,13], hemiparesis [1,10], memory disturbance [7-9], dementia-like symptoms or psychiatric symptoms [1-4,8-11,13,16,17], and disorientation [5-9,16] have been reported as primary symptoms. Patients with miliary brain metastasis can show an atypical clinical course and atypical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

et al. 2012

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IntroductionMiliary brain metastasis is an extremely rare form of brain metastasis which can present with atypical imaging findings. We report the case of a patient with miliary brain metastasis of lung cancer showing calcification in metastatic lesions.Case presentationA 68-year-old Japanese woman was diagnosed with lung adenocarcinoma. Brain computed tomography revealed multiple small calcified lesions in both cerebral hemispheres. Mutation of the epidermal growth factor receptor gene (exon 21, L858R) in lung cancer cells was detected, and treatment with gefitinib was initiated. A partial response was observed; however, the patient was readmitted to our hospital because of regrowth of the primary lesion and complaints of nausea, headache, and difficulty walking. Brain magnetic resonance imaging revealed scattered tiny nodules enhanced by gadolinium. A diagnosis of leptomeningeal carcinomatosis was made on the basis of cerebrospinal fluid cytology. The patient’s general status worsened, and she died 356 days after the day of first medical examination. Upon autopsy, the brain was found to be edematous and swollen. Lung carcinoma cells were diffusely disseminated on the meningeal surface. Metastatic foci of small nodular form, accompanied by calcifications, were also found in the brain parenchyma. We diagnosed miliary metastasis of lung carcinoma.ConclusionsTo the best of our knowledge, this is the third report of calcified miliary brain metastasis confirmed by autopsy. We describe calcified lesions that increased in size during the clinical course of nine months. Brain computed tomography findings that reveal multiple small calcified lesions in patients with malignancy should raise suspicion of miliary brain metastasis.

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Section: Discussionmentioning

confidence: 99%

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

et al. 2012

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“…The neuroradiological methods used to show it are not of equal value: it may be not detected on computed tomography (CT) and also hard to visualize on MRI but after gadolinium-based contrast medium injection it shows contrast enhancement and is conclusively demonstrated [1,2]. We found only two cases in the literature resembling ours.…”

Section: Discussionmentioning

confidence: 61%

“…Melanoma was taken into account as the most probable diagnosis because melanin deposits are spontaneously hyperintense on T1-weighted images. Lung cancer was a surprising diagnosis because metastases of this neoplasm (and of most of the neoplasms) are usually hyperintense on T2-weighted images and hypointense on T1-weighted images, with strong contrast enhancement, also in case of miliary spread [1]. …”

Section: Discussionmentioning

confidence: 99%

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Miliary brain metastases from papillary adenocarcinoma of the lung – unusual MRI pattern with histopathologic correlation

Bekiesińska‐Figatowska¹,

Kuczyńska-Zardzewiały²,

Klepacka³

et al. 2013

Pol J Radiol

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SummaryMiliary brain metastases are very rarely described in the literature but if they are, they are quite obvious on magnetic resonance imaging (MRI) and enhance after intravenous administration of the contrast medium. The authors presented a case of miliary metastatic spread to the brain which was invisible on computed tomography and hardly visible on MRI, i.e. as countless, tiny, slightly T1-hyperintense foci that did not enhance. The authors discussed a few T1-hyperintense brain lesions which did not include metastases (except for metastatic melanoma which was a radiological suggestion after brain MRI). Autopsy revealed papillary adenocarcinoma of the lung with numerous metastatic lesions in both cerebral and cerebellar hemispheres and the meninges.

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“…An association with EGFR exon 19 deletion and miliary adenocarcinoma of the lung in never-smoking patients was previously reported with one patient presenting no more than 3 brain lesions [1]. Miliary brain metastases from adenocarcinoma of the lung are a rare entity with only a few clinical and post-mortem histopathological correlations published [2]. Patients presented no or few neurologic symptoms, and one patient presented an exon 20 EGFR mutation [3].…”

Section: Discussionmentioning

confidence: 96%

Adenocarcinoma of the lung with miliary brain and pulmonary metastases with echinoderm microtubule-associated protein like 4-anaplastic lymphoma kinase translocation treated with crizotinib: A case report

et al. 2012

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Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation

Abstract: We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness.

Cited by 35 publications

References 10 publications

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

Miliary brain metastases from papillary adenocarcinoma of the lung – unusual MRI pattern with histopathologic correlation

Adenocarcinoma of the lung with miliary brain and pulmonary metastases with echinoderm microtubule-associated protein like 4-anaplastic lymphoma kinase translocation treated with crizotinib: A case report

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