Case Report: Atypical Solitary Brain Metastasis: The Role of MR Spectroscopy In Differential Diagnosis

Dusko Kozic; Nebojsa Lasica; Danica Grujicic; Savo Raicevic; Natasa Prvulovic Bunovic; Igor Nosek; Jasmina Boban

doi:10.3389/fonc.2022.866622

Case Report: Atypical Solitary Brain Metastasis: The Role of MR Spectroscopy In Differential Diagnosis

Front Oncol. 2022 Jul 22:12:866622. doi: 10.3389/fonc.2022.866622. eCollection 2022.

Authors

Dusko Kozic^{1

2}, Nebojsa Lasica^{1

3}, Danica Grujicic^{4

5

6}, Savo Raicevic⁷, Natasa Prvulovic Bunovic^{1

2}, Igor Nosek², Jasmina Boban^{1

2}

Affiliations

¹ Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
² Oncology Institute of Vojvodina, Center for Diagnostic Imaging, Sremska Kamenica, Serbia.
³ Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia.
⁴ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Neuro-Oncology Department, Clinic of Neurosurgery Clinical Center of Serbia, Belgrade, Serbia.
⁶ Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia.
⁷ Department of Pathology, Clinical Center of Serbia, Belgrade, Serbia.

Abstract

Background: Metastatic brain tumors are typically located at the cerebral hemispheres or the cerebellum and most frequently originate from primary breast or lung tumors. Metastatic lesions are usually associated with blood-brain barrier disruption, solid or ring-like contrast enhancement, and perilesional vasogenic edema on brain imaging. Even in cases where metastases are predominantly cystic, enhancement of the minor solid component can be detected. In contrast, non-enhancing secondary brain tumors were only reported in a patient after antiangiogenic treatment with bevacizumab.

Case report: We report a case of a 54-year-old male who presented with left-sided weakness and multiple seizures. Brain magnetic resonance imaging revealed a T2-weighted heterogeneous solid tumor in the right frontoparietal parasagittal region, with no apparent enhancement on T1-weighted post-contrast images and no evident perilesional edema. Further MRS analysis revealed markedly increased choline and lipid peaks. The patient underwent craniotomy for tumor removal. Histopathology revealed findings consistent with metastatic non-microcellular neuroendocrine lung cancer. positron emission tomography/computed tomography (PET/CT) revealed a stellate lesion within the right upper lung lobe, compatible with primary lung cancer.

Conclusion: Non-enhancing brain metastatic tumors are rarely reported in the literature, usually following antiangiogenic treatment. Here, we report the first ever case of a non-enhancing metastatic brain tumor with no prior history of antiangiogenic treatment, with particular emphasis on the importance of MRS analysis in atypical brain lesions.

Keywords: brain metastasis; case report; magnetic resonance spectroscopy; neuroendocrine tumor; nonenhancing.

Publication types

Case Reports