Abscess formation within brain metastasis

Abstract

Background: Brain abscesses are a potentially curable but life-threatening medical condition. Their occurrence within brain metastases has been exceptionally reported. In this study, we describe in detail this rare entity.

Case description: A previously healthy 64-year-old female was referred to our neurosurgical department with right-sided deviation of the oral commissure and a 7-day history of holocranial headache. Magnetic resonance imaging revealed a tumor in the right frontal lobe, exhibiting an iso-intense signal on T1-weighted images with heterogeneous enhancement. On diffusion-weighted imaging, the lesion displayed a hyperintense signal. A body computed tomography scan identified a lung tumor in the left superior lobe and a potential metastasis in the right adrenal gland. Intraoperative findings and histopathological examination revealed metastasis from lung adenocarcinoma. In addition, purulent content was noted within the abscess, and cultures identified Staphylococcus epidermidis and Streptococcus mitis.

Conclusion: Abscess formation within metastases is rarely diagnosed preoperatively, primarily because these lesions do not present with characteristic clinical or radiological features. Early recognition of this entity is crucial for establishing an appropriate treatment plan.

Keywords: Abscess formation; Lung cancer; Metastasis; Neuro-oncology.

Figure 1:

Magnetic resonance imaging reveals a mass lesion in the right frontal lobe. (a) T1-weighted images reveal a mass lesion in the right frontal lobe that appears iso-intense. (b) Gadolinium-enhanced sequences show irregular enhancement with an annular ring. (c) T2-weighted images demonstrate a heterogeneous signal. (d) Diffusion-weighted imaging (DWI) shows central areas of high signal intensity (restriction) interspersed with peripheral regions of low signal intensity (no restriction).

Figure 2:

(a) Hematoxylin and eosin stain of the brain lesion (×10). (b) Periodic acid–Schiff stain (×40). Epithelial cells and mucoid cytoplasmic inclusions – arrows – which determine their glandular origin.