Presentation
Headache.
Patient Data
Selected images from a post-contrast CT demonstrate sclerotic left frontal bone with underlying enhancement involving the leptomeninges and frontal lobe.
Selected MRI images confirm edema and overlying leptomeningeal and pachymeningeal enhancement.
Case Discussion
The patient went on to have a resection.
Histology:
Sections show metastatic carcinoma associated with dura and infiltrating brain parenchyma. Diffuse sheets and nests of neoplastic cells with foci of necrosis characterize the tumor. The individual tumor cells show pleomorphic nuclei with vesicular chromatin and prominent nucleoli, and distinct cellular borders.
Immunohistochemical studies show immunoreactivity for Gross cystic disease fluid protein (GCDFP) and CK7, and immuno-negativity for CK20. The tumor cells display strong Estrogen receptor immunoreactivity (+3), modest progesterone receptor immunoreactivity (+1), and variable and equivocal C-ERB (Her-2-neu) immunoreactivity (+2).
FINAL DIAGNOSIS: metastatic carcinoma, consistent with metastatic carcinoma of breast origin.