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Case Reports
. 2015 Oct 15:2015:bcr2015211777.
doi: 10.1136/bcr-2015-211777.

Multiple calcified brain metastases in a man with invasive ductal breast cancer

Nadine Ressl  1 , Stefan Oberndorfer  2
Affiliations
Case Reports

Multiple calcified brain metastases in a man with invasive ductal breast cancer

Nadine Ressl et al. BMJ Case Rep. .

Abstract

We report a case of a 52-year-old Caucasian man with invasive ductal carcinoma of the breast. One year after initial diagnosis, he developed a generalised epileptic seizure and neuroimaging showed multiple, calcified intracerebral lesions. Owing to these atypical cerebral imaging findings, comprehensive serological and cerebrospinal fluid analysis was conducted and a latent toxoplasmosis was suspected. In order to distinguish between metastases and an infectious disease, a cerebral biopsy was performed, which verified brain metastases. The patient received whole-brain radiotherapy. The last cerebral CT scan, 18 months later showed stable disease. Calcification of brain metastases in patients with breast cancer is very rare. Owing to their non-characteristic radiological appearance with a lack of contrast enhancement, diagnosis of metastases can be difficult. Infectious diseases should be considered within the diagnostic work up. Owing to possible pitfalls, we recommend a widespread differential diagnostic work up in similar cases, and even in cases with a confirmed primary tumour.

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Figures

Figure 1
Figure 1
Axial native CT images of the brain (A–C) showing multiple calcified lesions in both hemispheres in our patient with breast cancer. CCT of the patient with contrast medium (D–F) showing only rare contrast enhancement.
Figure 2
Figure 2
Preoperative MRI of the brain. Fluid-attenuated inversion recovery imaging (A–C) showing multiple calcified lesions with mild perilesional oedema in both frontal lobes, both parietal lobes, and in the left parieto-occipital and cerebellar region. Calcified metastases on T1-weighted images without contrast medium (D–F). Axial T1-weighted MRI with contrast medium (G–I) showing only rare contrast enhancement. T2*-weighted images with microbleeds within the intracerebral calcification (J–L).
Figure 3
Figure 3
Photomicrograph with detailed view of the intracerebral metastasis with necrosis and calcification (H&E stain ×100, arrow: necrosis).
See this image and copyright information in PMC

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