The online version of this article (doi:10.1186/1752-1947-6-279) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MI, RH, KK, SO, TI, KS, and KT were involved in treatment of the patient. TY, TM, TK, and SM interpreted the patient data and were involved in treatment planning. MI, RH, and SI were involved in preparing the manuscript. MS performed histological examination. All authors read and approved the final manuscript.
Miliary 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.
A 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.
To 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.
Nakamura H, Toyama M, Uezu K, Nakamoto A, Toda T, Saito A: Diagnostic dilemmas in oncology: Case 1. Lung cancer with miliary brain metastases undetected by imaging studies. J Clin Oncol. 2001, 19: 4340-4341. PubMed
Iguchi Y, Mano K, Goto Y, Nakano T, Nomura F, Shimokata T, Iwamizu-Watanabe S, Hashizume Y: Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation. Neuroradiology. 2007, 49: 35-39. 10.1007/s00234-006-0152-6. CrossRefPubMed
Nemzek W, Poirier V, Salamat MS, Yu T: Carcinomatous encephalitis (miliary metastases): lack of contrast enhancement. Am J Neuroradiol. 1993, 14: 540-542. PubMed
Balestreri L, Canzonieri V, Morassut S: Calcified gastric cancer: CT findings before and after chemotherapy, case report and discussion of the pathogenesis of this type of calcification. Clinical Imaging. 1995, 21: 122-125. CrossRef
Olsen WL, Winkler ML, Ross DA: Carcinomatous encephalitis: CT and MR findings. AJNR Am J Neuroradiol. 1987, 8: 553-554. PubMed
- Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report
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