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Case Reports
. 2022 Jul 22:12:866622.
doi: 10.3389/fonc.2022.866622. eCollection 2022.

Case Report: Atypical Solitary Brain Metastasis: The Role of MR Spectroscopy In Differential Diagnosis

Dusko Kozic  1   2 , Nebojsa Lasica  1   3 , Danica Grujicic  4   5   6 , Savo Raicevic  7 , Natasa Prvulovic Bunovic  1   2 , Igor Nosek  2 , Jasmina Boban  1   2
Affiliations
Case Reports

Case Report: Atypical Solitary Brain Metastasis: The Role of MR Spectroscopy In Differential Diagnosis

Dusko Kozic et al. Front Oncol. .

Abstract

Background: Metastatic brain tumors are typically located at the cerebral hemispheres or the cerebellum and most frequently originate from primary breast or lung tumors. Metastatic lesions are usually associated with blood-brain barrier disruption, solid or ring-like contrast enhancement, and perilesional vasogenic edema on brain imaging. Even in cases where metastases are predominantly cystic, enhancement of the minor solid component can be detected. In contrast, non-enhancing secondary brain tumors were only reported in a patient after antiangiogenic treatment with bevacizumab.

Case report: We report a case of a 54-year-old male who presented with left-sided weakness and multiple seizures. Brain magnetic resonance imaging revealed a T2-weighted heterogeneous solid tumor in the right frontoparietal parasagittal region, with no apparent enhancement on T1-weighted post-contrast images and no evident perilesional edema. Further MRS analysis revealed markedly increased choline and lipid peaks. The patient underwent craniotomy for tumor removal. Histopathology revealed findings consistent with metastatic non-microcellular neuroendocrine lung cancer. positron emission tomography/computed tomography (PET/CT) revealed a stellate lesion within the right upper lung lobe, compatible with primary lung cancer.

Conclusion: Non-enhancing brain metastatic tumors are rarely reported in the literature, usually following antiangiogenic treatment. Here, we report the first ever case of a non-enhancing metastatic brain tumor with no prior history of antiangiogenic treatment, with particular emphasis on the importance of MRS analysis in atypical brain lesions.

Keywords: brain metastasis; case report; magnetic resonance spectroscopy; neuroendocrine tumor; nonenhancing.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Right frontal parafalcine tumor evident on T2 sagittal (A) and FLAIR axial images (B), associated with typical high choline and lipid peaks on single-voxel MR spectroscopy (C) and lack of expected enhancement on post contrast T1 sagittal image (D).
Figure 2
Figure 2
(A) On hematoxylin and eosin staining tumor cells have scant to moderate amount of eosinophillic cytoplasm, and irregular nuclei with “salt and pepper” chromatin. Brisk mitotic activity can be seen. (B) On immunohistochemical staining tumor cells nuclei strongly and diffusely express TTF-1. (C) The proliferative Ki-67 index is high (magnification, x400).
Figure 3
Figure 3
An evident lesion in the upper lobe of the right lung on CT scan (A) with an avid FDG uptake (B) of the compatible with cancer on PET scan.
See this image and copyright information in PMC

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