|Year : 2019 | Volume
| Issue : 3 | Page : 194-195
Unusual presentation of intraventricular metastases from small-cell carcinoma of the lung
Reddy Ravikanth, Kanagasabai Kamalasekar
Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
|Date of Submission||02-Oct-2018|
|Date of Decision||13-Nov-2018|
|Date of Acceptance||16-Dec-2018|
|Date of Web Publication||13-Aug-2019|
Department of Radiology, Holy Family Hospital, Thodupuzha - 685 605, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ravikanth R, Kamalasekar K. Unusual presentation of intraventricular metastases from small-cell carcinoma of the lung. CHRISMED J Health Res 2019;6:194-5
|How to cite this URL:|
Ravikanth R, Kamalasekar K. Unusual presentation of intraventricular metastases from small-cell carcinoma of the lung. CHRISMED J Health Res [serial online] 2019 [cited 2019 Oct 17];6:194-5. Available from: http://www.cjhr.org/text.asp?2019/6/3/194/264373
| Description|| |
Our case report involves a 64-year-old male patient who presented to our hospital with the chief complaint of dizziness and double vision for 1 week. He was diagnosed with small-cell carcinoma of the lung in the past. His magnetic resonance scan revealed multiple intraventricular and intraparenchymal metastases from small-cell carcinoma of the lung, which is very rare [Figure 1], [Figure 2], [Figure 3], [Figure 4]. High doses of steroids were started, but his mental status got worse as had symptoms of psychomotor agitation. The patient died 3 days after without any chance of further treatment. We report this case to increase the awareness of this rare metastasis of small-cell carcinoma of the lung.
|Figure 1: Axial diffusion-weighted imaging–magnetic resonance image demonstrating multiple subependymal foci showing diffusion restriction (arrows)|
Click here to view
|Figure 2: Axial T2-weighted–magnetic resonance image demonstrating multiple hyperintense lesions involving bilateral cerebellar hemispheres with surrounding vasogenic edema (circles)|
Click here to view
|Figure 3: Axial T1+C–magnetic resonance image demonstrating multiple enhancing lesions in the right temporal lobe (circle) and lateral ventricles (arrows)|
Click here to view
|Figure 4: Coronal T1+C–magnetic resonance image demonstrating multiple subependymal enhancing lesions (circle) and intraparenchymal enhancing lesions in bilateral cerebellar hemispheres and the vermis (arrows)|
Click here to view
| Discussion|| |
Primary lung tumors account for 30%–60% of all brain metastasis cases. Adenocarcinoma of the lung is more likely to metastasize than squamous cell carcinoma, and 45% are solitary. Most of these patients present with features of nonlocalized raised intracranial pressure such as headache, vomiting, and altered sensorium. Parenchymal metastases are more common than intraventricular dissemination.
The differential diagnosis for intraventricular neoplasms can be broad, and many of them have similar patterns of signal intensity and contrast enhancement at imaging. The tumors of lateral ventricle arise from the walls of the ventricle or tissues within and around the ventricle notably choroid plexus, septum pellucidum, and thalamus. Most of the tumors are low grade and slow growing, which includes astrocytoma, oligodendroglioma, choroid plexus papilloma, and meningioma. Few of them are highly malignant like malignant ependymoma and choroid plexus carcinoma. Metastasis accounts for a rare differential diagnosis of intraventricular mass. True intraventricular metastases arise within the ventricle, while parenchymal metastases, which protrude into the ventricle, are nodular deposits, seen in meningeal carcinomatosis, and these should not be classified as intraventricular metastasis.
Intraventricular metastases are a very rare finding. A few intracranial tumors and some extracranial tumors metastasize to the ventricles. The most common site of intraventricular metastasis is the trigone of the lateral ventricles due to high vascularity of the choroid plexuses. The next most common sites are the 4th and 3rd ventricles. Primary tumors of renal cell carcinoma, melanoma, breast carcinoma, lung carcinoma, squamous cell carcinoma of the uterine cervix, and colon carcinoma can metastasize to the ventricles. Whenever a patient with cancer presents an altered mental status, a computed tomography/magnetic resonance imaging scan should be performed to check if central nervous system metastases exist. Radical surgical resection seems to be the most relevant option for several patients with intraventricular metastases.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Seute T, Leffers P, ten Velde GP, Twijnstra A. Detection of brain metastases from small cell lung cancer: Consequences of changing imaging techniques (CT versus MRI). Cancer 2008;112:1827-34.
Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 2002;94:2698-705.
Lee MH, Kong DS, Seol HJ, Nam DH, Lee JI. Risk of seizure and its clinical implication in the patients with cerebral metastasis from lung cancer. Acta Neurochir (Wien) 2013;155:1833-7.
Healy JF, Rosenkrantz H. Intraventricular metastases demonstrated by cranial computed tomography. Radiology 1980;136:124.
Lekic M, Kovac V, Triller N, Knez L, Sadikov A, Cufer T, et al.
Outcome of small cell lung cancer (SCLC) patients with brain metastases in a routine clinical setting. Radiol Oncol 2012;46:54-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]