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Case Reports
. 2022 Feb 16;10(5):1723-1728.
doi: 10.12998/wjcc.v10.i5.1723.

Unusual magnetic resonance imaging findings of brain and leptomeningeal metastasis in lung adenocarcinoma: A case report

Na Li  1 , Yu-Jun Wang  2 , Fang-Mei Zhu  1 , Shui-Tang Deng  1
Affiliations
Case Reports

Unusual magnetic resonance imaging findings of brain and leptomeningeal metastasis in lung adenocarcinoma: A case report

Na Li et al. World J Clin Cases. .

Abstract

Background: Metastatic tumors are the most common malignancies of central nervous system in adults, and the frequent primary lesion is lung cancer. Brain and leptomeningeal metastases are more common in patients with non-small-cell lung cancer harboring epidermal growth factor receptor mutations. However, the coexist of brain metastasis with leptomeningeal metastasis (LM) in isolated gyriform appearance is rare.

Case summary: We herein presented a case of a 76-year-old male with an established diagnosis as lung adenocarcinoma with gyriform-appeared cerebral parenchymal and leptomeningeal metastases, accompanied by mild peripheral edema and avid contrast enhancement on magnetic resonance imaging. Surgical and pathological examinations confirmed the brain and leptomeningeal metastatic lesions in the left frontal cortex, subcortical white matter and local leptomeninges.

Conclusion: This case was unique with respect to the imaging findings of focal gyriform appearance, which might be caused by secondary parenchymal brain metastatic tumors invading into the leptomeninges or coexistence with LM. Radiologists should be aware of this uncommon imaging presentation of tumor metastases to the central nervous system.

Keywords: Brain metastasis; Case report; Epidermal growth factor receptor; Leptomeningeal metastasis; Lung cancer; Magnetic resonance imaging.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Results of pathologic diagnosis and cerebrospinal fluid cytology. A: H&E staining, magnification 100×, demonstrated abnormal epithelioid cell nests in the left frontal lesion; B: Cerebrospinal fluid (CSF) cytology revealed malignant cells in the CSF.
Figure 2
Figure 2
76-year-old male with brain and leptomeningeal metastases. Magnetic resonance imaging (3.0 T) demonstrated a predominately T2/FLAIR hyperintense gyriform mass in the left frontal lobe (A: T2WI; B: Axial FLAIR), which is associated with minimal peripheral edema, mild restricted diffusion (C: Diffusion-weighted image), and avid contrast enhancement (D: Non-contrasted Axial T1WI; E: Sagittal T1WI after gadolinium administration). Leptomeningeal lesions were also observed (black arrow), (F: Axial post contrast).
See this image and copyright information in PMC

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