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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 82-84

Multiple intraventricular brain metastasis in a case of non-small cell lung carcinoma


Department of Radiology and Orthopaedics, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India

Date of Submission19-Feb-2019
Date of Acceptance16-Apr-2019
Date of Web Publication28-Nov-2019

Correspondence Address:
Dr. Paramdeep Singh
Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/VIT.VIT_14_19

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  Abstract 


Intraventricular metastasis is a rare entity encountered in very few malignancies. Although the renal cell carcinoma is the most common primary causing this rare event, due to overall more incidences of lung carcinomas, the intraventricular metastasis by lung cancer is the most common cause. Our patient was a diagnosed case of non-small cell carcinoma and non-small cell lung cancer. (NSCLC) with an advanced stage of disease at the time of presentation that resulted in a poor prognosis. The most common metastatic site in non-small cell carcinoma is bone, followed by the lungs, brain, liver, and adrenal glands. The treatment for metastatic NSCLC consists of systemic therapy using cytotoxic and molecularly-targeted agents and palliative radiotherapy for symptomatic metastases. Surgical resection or gamma knife can be considered for those with isolated brain metastasis for better prognosis.

Keywords: Brain, intraventricular, lung cancer, metastasis


How to cite this article:
Kaur R, Aggarwal S, Gadhavi S, Dahuja A, Singh P. Multiple intraventricular brain metastasis in a case of non-small cell lung carcinoma. Vasc Invest Ther 2019;2:82-4

How to cite this URL:
Kaur R, Aggarwal S, Gadhavi S, Dahuja A, Singh P. Multiple intraventricular brain metastasis in a case of non-small cell lung carcinoma. Vasc Invest Ther [serial online] 2019 [cited 2019 Dec 14];2:82-4. Available from: http://www.vitonline.org/text.asp?2019/2/3/82/271904




  Introduction Top


We present a rare case of non small cell lung cancer who had intraventricular metastasis on imaging.


  Case Report Top


A 72-year-old male patient who was a known case of non-small cell carcinoma presented with clinical findings of a headache and difficulty in speaking. He was a heavy smoker (50 pack years) with a history of hypertension and chronic bronchitis. During the initial presentation, he had right-sided pleuritic chest pain with a fever and cough for 15 days. He also gave a history of significant weight loss, and when contrast-enhanced computed tomography (CECT) chest was done that revealed a spiculated ill-defined peripheral heterogeneously enhancing mass in the right lower lobe of the lung. The histopathological analyses of the same confirmed non-SCLC.

CECT of the brain was done after the patient presented with neurological complaints, and the CT revealed multiple lesions in body and the frontal horn region of the lateral ventricles [Figure 1]a and [Figure 1]b with few lesions along temporal horns of ventricles bilaterally [Figure 2]. There was also mild adjacent parenchymal involvement at a few places. There were other similar lesions along the walls of the third and fourth ventricle. Radiological findings were compatible with multiple intraventricular metastases and parenchymal involvement. High doses of steroids were started, but his neurological status deteriorated. The patient died after 3 months without any chance of other treatments.
Figure 1: (a) Noncontrast computed tomography axial brain is showing ill-defined slightly hyperattenuating lesion involving the frontal horn of the left lateral ventricle. (b). Contrast-enhanced computed tomography axial images showing irregular enhancing nodular lesions along the walls of the lateral ventricles (L > R). There is also noted enhancing smooth thickening of the walls at places

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Figure 2: Contrast-enhanced computed tomography axial images at the level of suprasellar cistern showing an enhancing lesion in the temporal horn of the right lateral ventricle and mild wall thickening in the left temporal horn

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  Case Discussion Top


Lung cancer is the leading primary tumor causing 40%–50% of cases of intraventricular metastasis.[1],[2] In non-small cell lung cancer (NSCLC), there is a risk of brain metastases around 15%–20% at the time of diagnosis and this increases up to 50%–60% when the epidermal growth factor receptor mutation or anaplastic lymphoma kinase rearrangement is present.[3],[4] intraventricular metastasis occurs in <5% of cancer patients from epithelial malignancies such as the kidney, breast, gastric, pituitary, thyroid or bladder carcinomas, lung or colon adenocarcinomas, lymphomas, and melanomas.[5] Distant metastases are seen in 30%–40% of patients with non-small cell lung cancer (NSCLC) at the time of the diagnosis. Furthermore, the overall incidence of metastasis is 34.3%, 32.1%, 28.4%, 16.7%, 13.4%, and 9.5% to the bone, lung, brain, adrenal gland, liver, and extrathoracic lymph node, respectively.[6],[7] Hence, the brain is the third-most common metastatic site for NSCLC. The site of intracranial metastasis is mostly attributed to parenchymal blood flow with 80% of metastases localizing to cerebral hemispheres, 15% to the cerebellum, and 3% to the basal ganglia.[8] Moreover, rarely, tumors may metastasize to the choroid plexus, ventricles, pituitary gland, or leptomeninges.[9] There is a very low incidence of patients presenting with ventricular metastasis in the brain.

Paradoxically, there is an increased number of patients being diagnosed with brain metastases at the time of diagnosis or on follow-up due to extensively used imaging techniques as well as increased overall survival due to therapeutic advances.[10] Accordingly, there is also a relative increased risk of brain metastases in patients with younger age at the time of the diagnosis, larger tumor size, greater lymphovascular invasion, and hilar nodal involvement.[11] After the introduction of whole-brain radiation therapy (WBRT) in the 1950s, it became standard treatment for brain metastases in different types of cancer; however the overall survival of patients is still only 3–6 months even after WBRT.[12],[13] Other treatment options are determined by histology, stage, general health, and comorbid conditions of patients. Our patient was followed on with radical treatment up to 3 months of the diagnosis after which the patient died. Radiotherapy improves neurocognitive function as prophylactic cranial irradiation is a part of the standard treatment.[14] Surgical resection of isolated brain metastasis is being tried on with better prognosis; however, with multiple site involvement, cranial irradiation is considered mainstay of the treatment.

Learning points:

  • Brain metastasis is one of the most common intracranial neoplasms with an important cause of cancer-related morbidity and mortality in the world
  • Tumors originating from the lung, renal, breast, as well as melanomas and gastrointestinal adenocarcinomas, are responsible for 80% of brain metastasis with a low frequency of intraventricular metastases. The differential diagnosis would be primary intraventricular neoplasm
  • In case of neurological deterioration, a CT scan should be performed to rule out central nervous system metastases. Furthermore, there are present brain metastases in 45% of patients when magnetic resonance imaging is included during the staging evaluation hence depicting the need for thorough workup and adequate management
  • Although radical surgical resection seems to be a suitable option for several patients with intraventricular metastases with the longest survival time, this treatment is not possible for many patients.


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan detroit cancer surveillance system. J Clin Oncol 2004;22:2865-72.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Zhang I, Zaorsky NG, Palmer JD, Mehra R, Lu B. Targeting brain metastases in ALK-rearranged non-small-cell lung cancer. Lancet Oncol 2015;16:e510-21.  Back to cited text no. 3
    
4.
Johung KL, Yeh N, Desai NB, Williams TM, Lautenschlaeger T, Arvold ND, et al. Extended survival and prognostic factors for patients with ALK-rearranged non-small-cell lung cancer and brain metastasis. J Clin Oncol 2016;34:123-9.  Back to cited text no. 4
    
5.
Hassaneen W, Suki D, Salaskar AL, Wildrick DM, Lang FF, Fuller GN, et al. Surgical management of lateral-ventricle metastases: Report of 29 cases in a single-institution experience. J Neurosurg 2010;112:1046-55.  Back to cited text no. 5
    
6.
Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, et al. Cancer incidence and incidence rates in Japan in 2008: A study of 25 population-based cancer registries for the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol 2014;44:388-96.  Back to cited text no. 6
    
7.
Little AG, Gay EG, Gaspar LE, Stewart AK. National survey of non-small cell lung cancer in the United States: Epidemiology, pathology and patterns of care. Lung Cancer 2007;57:253-60.  Back to cited text no. 7
    
8.
Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int 2013;4:S209-19.  Back to cited text no. 8
    
9.
Meyer PC, Reah TG. Secondary neoplasms of the central nervous system and meninges. Br J Cancer 1953;7:438-48.  Back to cited text no. 9
    
10.
Ali A, Goffin JR, Arnold A, Ellis PM. Survival of patients with non-small-cell lung cancer after a diagnosis of brain metastases. Curr Oncol 2013;20:e300-6.  Back to cited text no. 10
    
11.
Hubbs JL, Boyd JA, Hollis D, Chino JP, Saynak M, Kelsey CR. Factors associated with the development of brain metastases: Analysis of 975 patients with early stage nonsmall cell lung cancer. Cancer 2010;116:5038-46.  Back to cited text no. 11
    
12.
Hatiboglu MA, Wildrick DM, Sawaya R. The role of surgical resection in patients with brain metastases. Ecancermedicalscience 2013;7:308.  Back to cited text no. 12
    
13.
Gaspar LE, Mehta MP, Patchell RA, Burri SH, Robinson PD, Morris RE, et al. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: A systematic review and evidence-based clinical practice guideline. J Neurooncol 2010;96:17-32.  Back to cited text no. 13
    
14.
Chi A, Komaki R. Treatment of brain metastasis from lung cancer. Cancers (Basel) 2010;2:2100-37.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]



 

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