Li Na, Wang Yu-Jun, Zhu Fang-Mei, Deng Shui-Tang
Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China.
Department of Radiology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou 310012, Zhejiang Province, China.
World J Clin Cases. 2022 Feb 16;10(5):1723-1728. doi: 10.12998/wjcc.v10.i5.1723.
Metastatic tumors are the most common malignancies of central nervous system in adults, and the frequent primary lesion is lung cancer. Brain and leptomeningeal metastases are more common in patients with non-small-cell lung cancer harboring epidermal growth factor receptor mutations. However, the coexist of brain metastasis with leptomeningeal metastasis (LM) in isolated gyriform appearance is rare.
We herein presented a case of a 76-year-old male with an established diagnosis as lung adenocarcinoma with gyriform-appeared cerebral parenchymal and leptomeningeal metastases, accompanied by mild peripheral edema and avid contrast enhancement on magnetic resonance imaging. Surgical and pathological examinations confirmed the brain and leptomeningeal metastatic lesions in the left frontal cortex, subcortical white matter and local leptomeninges.
This case was unique with respect to the imaging findings of focal gyriform appearance, which might be caused by secondary parenchymal brain metastatic tumors invading into the leptomeninges or coexistence with LM. Radiologists should be aware of this uncommon imaging presentation of tumor metastases to the central nervous system.
转移性肿瘤是成人中枢神经系统最常见的恶性肿瘤，最常见的原发灶是肺癌。脑转移和软脑膜转移在携带表皮生长因子受体突变的非小细胞肺癌患者中更为常见。然而，孤立脑回样外观的脑转移与软脑膜转移（LM）并存的情况很少见。
我们在此报告一例76岁男性患者，确诊为肺腺癌，伴有脑回样外观的脑实质和软脑膜转移，磁共振成像显示轻度外周水肿和明显强化。手术和病理检查证实左侧额叶皮质、皮质下白质和局部软脑膜存在脑和软脑膜转移病灶。
该病例的局灶性脑回样外观影像学表现独特，可能是由于继发性脑实质转移瘤侵犯软脑膜或与LM并存所致。放射科医生应注意这种中枢神经系统肿瘤转移的罕见影像学表现。
