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01.12.2012 | Case report | Ausgabe 1/2012 Open Access

Journal of Medical Case Reports 1/2012

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2012
Autoren:
Minehiko Inomata, Ryuji Hayashi, Kenta Kambara, Seisuke Okazawa, Shingo Imanishi, Tomomi Ichikawa, Kensuke Suzuki, Toru Yamada, Toshiro Miwa, Tatsuhiko Kashii, Shoko Matsui, Kazuyuki Tobe, Masakiyo Sasahara
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-6-279) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Introduction

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.

Case presentation

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.

Conclusions

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.

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Zusatzmaterial
Authors’ original file for figure 1
13256_2012_2210_MOESM1_ESM.pdf
Authors’ original file for figure 2
13256_2012_2210_MOESM2_ESM.tiff
Authors’ original file for figure 3
13256_2012_2210_MOESM3_ESM.pdf
Authors’ original file for figure 4
13256_2012_2210_MOESM4_ESM.pdf
Literatur
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