Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1723-1728
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1723
Unusual magnetic resonance imaging findings of brain and leptomeningeal metastasis in lung adenocarcinoma: A case report
Na Li, Yu-Jun Wang, Fang-Mei Zhu, Shui-Tang Deng
Na Li, Fang-Mei Zhu, Shui-Tang Deng, Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Yu-Jun Wang, Department of Radiology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou 310012, Zhejiang Province, China
Author contributions: Li N and Wang YJ designed research; Li N and Zhu FM performed research; Li N, Zhu FM, Deng ST analyzed data; Li N wrote the letter; Zhu FM and Wang YJ revised the letter.
Supported by the Medical and Health Science and Technology Planning Project, No. 2019319609.
Informed consent statement: Informed consent was obtained from the patient’s guardian for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Jun Wang, Chief Doctor, Department of Radiology, Zhejiang Provincial Hospital of Chinese Medicine, No. 54 Youdian Road, Hangzhou 310012, Zhejiang Province, China. 981861280@qq.com
Received: October 18, 2021
Peer-review started: October 18, 2021
First decision: October 27, 2021
Revised: November 4, 2021
Accepted: January 8, 2022
Article in press: January 8, 2022
Published online: February 16, 2022
Processing time: 116 Days and 1.7 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Brain metastasis, Leptomeningeal metastasis, Magnetic resonance imaging, Lung cancer, Epidermal growth factor receptor, Case report

Core Tip: Patients with non-small-cell lung cancer harboring epidermal growth factor receptor (EGFR) mutations were more susceptible to develop into brain or leptomeningeal metastases when compared to those with wild-type EGFR. However, parenchymal brain metastasis combined with leptomeningeal metastasis (LM) in isolated gyriform appearance is rare. We herein presented a case of a 76-year-old male with EGFR-mutated lung adenocarcinoma metastases of the brain with isolated gyriform appearance in imaging findings. We speculated that the focal gyriform lesions were likely to be caused by secondary leptomeningeal invasion from parenchymal brain metastatic tumors or coexisting of parenchymal brain metastasis with LM.