Cystic brain metastases radiologically simulating neurocysticercosis
Keywords:
Neoplasm metastasis, Neurocysticercosis, Cysticercus, Brain diseases, Magnetic resonance imagingAbstract
CONTEXT: Brain metastases are common complications of cancer. Magnetic resonance imaging (MRI), the main diagnostic imaging method in these cases, rarely shows cystic images. CASE REPORT: The patient was a 45-year-old woman who had had severe headache for a month that was refractory to medication, and had previously had breast cancer, which had been treated. The MRI showed the criteria for neurocysticercosis. Since there was no improvement with clinical treatment, we chose to excise the lesions. Histopathological analysis showed an epithelioid malignant neoplasm. CONCLUSION: From immunohistochemical analysis, it was concluded that this was a metastasis of breast carcinoma. Even when the MRI is not characteristic of cerebral metastasis, this hypothesis needs to be ruled out in patients with a previous history of cancer.
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References
Burger PC, Scheithauer BW. Atlas of tumor pathology. Tumors of the central nervous system. Washington: American Registry of Pathology; 1993.
do Amaral LL, Ferreira RM, da Rocha AJ, Ferreira NP. Neurocysticercosis: evaluation with advanced magnetic resonance techniques and atypical forms. Top Magn Reson Imaging. 2005;16(2):127-44.
Machado LR. Diagnóstico da neurocisticercose: uma questão fechada? [The diagnosis of neurocysticercosis: a closed question?] Arq Neuropsiquiatr. 2010;68(1):1-2.
Colli BO, Carlotti CG Jr, Assirati JA Jr, et al. Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors. Neurosurg Focus. 2002;12(6):e3.
Agapejev S. Aspectos clínico-epidemiológicos da neurocisticercose no Brasil: análise crítica [Clinical and epidemiological aspects of neurocysticercosis in Brazil: a critical approach]. Arq Neuropsiquiatr. 2003;61(3B):822-8.
Grazziotin AL, Fontalvo MC, Santos MBF, Monego F, Grazziotin AL. Perfil epidemiológico de pacientes com neurocisticercose diagnosticados por tomografia computadorizada em Curitiba, Brazil [Epidemiologic pattern of patients with neurocysticercosis diagnosed by computed tomography in Curitiba, Brazil]. Arq Neuropsiquiatr. 2010;68(2):269-72.
Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology. 2006;239(3):650-64.
Mishra AM, Gupta RK, Jaggi RS, et al. Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr. 2004;28(4):540-7.
CoulibalyB,GautierG,FuentesS,RanqueS,BouvierC.Neurocysticercose cérébrale au stade de dégénérescence: diagnostic différentiel des métastases cérébrales [Degenerating neurocysticercosis cysts: differential diagnosis with cerebral metastasis]. Rev Neurol (Paris). 2008;164(11):948-52.
Tripathi RP, Gupta A, Gupta S, et al. Co-existence of dual intracranial pathology clinical relevance of proton MRS. Neurol India. 2000;48(4):365-9.
Garg RK, Sinha MK. Multiple ring-enhancing lesions of the brain. J Postgrad Med. 2010;56(4):307-16.
Omuro AM, Leite CC, Mokhtari K, Delattre JY. Pitfalls in the diagnosis of brain tumours. Lancet Neurol. 2006;5(11):937-48.
Park SY, Kim BH, Kim JH, Lee S, Kang GH. Panelsofimmunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch Pathol Lab Med. 2007;131(10):1561-7.
Tot T. Cytokeratins 20 and 7 as biomarkers: usefulness in discriminating primary from metastatic adenocarcinoma. Eur J Cancer. 2002;38(6):758-63.
Schwarz RE, Klimstra DS, Turnbull AD. Metastatic breast cancer masquerading as gastrointestinal primary. Am J Gastroenterol. 1998;93(1):111-4.
Machado AB, Machado AA, Barbuto JA, de Oliveira RM. Central nervous system metastases from breast carcinoma. A clinical and laboratorial study in 47 patients. Arq Neuropsiquiatr. 1998;56(2):188-92.
Ersahin M, Kilic K, Gögüsgeren MA, et al. Multiple brain metastases from malignant thymoma. J Clin Neurosci. 2007;14(11):1116-20.
Reddy JS, Mishra AM, Behari S, et al. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 2006;66(3):246-50; discussion 250-1.
Reich W, Schuchardt V, Hagen T, et al. Differential diagnosis of intracranial ring enhancing cystic mass lesions--role of diffusion- weighted imaging (DWI) and diffusion-tensor imaging (DTI). Clin Neurol Neurosurg. 2010;112(3):218-25.
Nath K, Agarwal M, Ramola M, et al. Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesion. Magn Reson Imaging. 2009;27(2):198-206.
