Inomata Minehiko, Hayashi Ryuji, Kambara Kenta, Okazawa Seisuke, Imanishi Shingo, Ichikawa Tomomi, Suzuki Kensuke, Yamada Toru, Miwa Toshiro, Kashii Tatsuhiko, Matsui Shoko, Tobe Kazuyuki, Sasahara Masakiyo
First Department of Internal Medicine, University of Toyama, Toyama City, 930-0194, Japan.
J Med Case Rep. 2012 Sep 4;6:279. doi: 10.1186/1752-1947-6-279.
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.
粟粒性脑转移是脑转移的一种极其罕见的形式，可表现出非典型的影像学表现。我们报告一例肺癌粟粒性脑转移患者，其转移病灶出现钙化。
一名68岁的日本女性被诊断为肺腺癌。脑部计算机断层扫描显示双侧大脑半球有多个小钙化灶。检测到肺癌细胞中表皮生长因子受体基因（第21外显子，L858R）突变，遂开始使用吉非替尼治疗。观察到部分缓解；然而，患者因原发灶复发以及出现恶心、头痛和行走困难等症状而再次入院。脑部磁共振成像显示钆增强的散在小结节。根据脑脊液细胞学检查诊断为软脑膜癌病。患者的一般状况恶化，在首次就诊后356天死亡。尸检时发现脑部水肿且肿胀。肺癌细胞弥漫性播散于脑膜表面。脑实质内也发现了伴有钙化的小结节状转移灶。我们诊断为肺癌粟粒性转移。
据我们所知，这是第三例经尸检证实的钙化性粟粒性脑转移报告。我们描述了在九个月的临床过程中大小增加的钙化灶。在恶性肿瘤患者中，脑部计算机断层扫描发现多个小钙化灶应引起对粟粒性脑转移的怀疑。
