Presentation
Heavy smoker presented to the ER after a witnessed first seizure.
Patient Data
Left-sided occipital cortically based 15 mm lesion associated with vasogenic white matter edema.
Left occipital cortically based enhancing solid lesion about 17 mm associated with vasogenic white matter edema, showing low signal on T2, high signal on T1 and peripheral restricted diffusion.
• 2 cm irregular shaped nodule in the left upper lung lobe with a linear tail toward the left hilum
• mediastinal lymphadenopathy (30 x 18 mm lymph node in the aortopulmonary window, 14 x 9 mm lymph node in the right hilum)
• lung emphysema, band of old infection changes in the right middle lung lobe
• 6 x 3 cm soft tissue mass causing focal bone destruction in the lateral aspect of the right fifth rib, invading the right chest wall muscles
• 3.5 x 2.3 cm soft tissue mass infiltrating the right T5 posterior elements and adjacent spinal muscles with medially encroachment of the epidural space
• lytic bone lesion seen in the posterior aspect of the T10 vertebral body with an additional tiny lytic lesion seen in the T12 vertebral body
• multiple variable-sized hypodense mass lesions in the hepatic lobes the largest measuring about 5.5 cm
• nodular appearance of the left adrenal gland
• focal hyperdense area in the anterior pole of the spleen measuring about 2.5 cm
• small sliding hiatus hernia
• large number of small colonic diverticula, no acute inflammatory changes at the time of the exam
• right sided indirect inguinal urinary bladder hernia
Case Discussion
While most brain metastases demonstrate facilitated diffusion, restricted diffusion could be present in two situations:
hemorrhagic metastasis, which could be easily confirmed by non-enhanced brain CT or SWI brain MRI
highly cellular malignant tumors like in the case of metastatic neuroendocrine bronchogenic carcinoma
The patient's histopathology report revealed metastatic large-cell neuroendocrine carcinoma of the lung (LCNEC). A rare and very aggressive form of lung cancer, LCNEC exhibits similarities to both small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC).
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