Carcinomatous encephalitis, also called miliary brain metastasis, is a rare form of metastatic disease in the central nervous system, which was originally described by Madow and Alpers. It has been reported as secondary to melanoma, lung carcinoma, and breast carcinoma (1,2). The associated clinical symptoms and cerebrospinal fluid (CSF) findings are typically nonspecific, but CSF may show a slight increase in total proteins. Brain MRI may show small foci of high signal intensity or perivascular enhancement at T1-weighted and fluid-attenuated inversion recovery sequences; however, these findings have a wide differential diagnosis, including inflammatory and infectious conditions. Therefore, clinical context is crucial, and pathologic diagnosis remains the reference standard (3,4) (Figs 1–3).
Figure 1:
Images from brain MRI in a 43-year-old woman with tongue squamous cell carcinoma with lung metastasis who presented with right side incoordination, dysarthria, and imbalance. Cerebrospinal fluid findings were unremarkable, and (A) axial T2-weighted MR image shows high, diffuse pontine hyperintensity (arrows) with (B) nodular perivascular enhancement (arrow) on axial T1-weighted MR image.
Figure 3:
Photomicrograph of specimen from cerebral biopsy of the right pons shows neoplastic cells (arrows) with squamous differentiation (keratin) invasive in brain tissue. (Hematoxylin-eosin stain; original magnification, ×200.) Immunohistochemical analysis (not shown) confirmed squamous differentiation with expression of high-molecular-weight cytokeratin (CK5/6) and p63.
Figure 2:
Image from cerebral fluorodeoxyglucose PET/CT in the patient shows hypermetabolism in the pons (arrow), with a maximum standardized uptake value of 6.4.
Footnotes
Authors declared no funding for this work.
Disclosures of conflicts of interest: I.S.A. No relevant relationships. O.F. No relevant relationships. R.M. Study materials provided by Hospital Sírio-Libanês, São Paulo, Brazil. M.F.d.L.D. No relevant relationships. C.T.A. No relevant relationships. H.W.L. No relevant relationships.
Keywords: Neuro-Oncology, CNS, MR Imaging, PET/CT
References
- 1. Ribeiro HB , Paiva TF Jr , Mamprin GP , Gorzoni ML , Rocha AJ , Lancellotti CL. Carcinomatous encephalitis as clinical presentation of occult lung adenocarcinoma: case report . Arq Neuropsiquiatr 2007. ; 65 ( 3b 3B ): 841 – 844 . [DOI] [PubMed] [Google Scholar]
- 2. Bekiesińska-Figatowska M , Kuczyńska-Zardzewiały A , Klepacka T , et al . Miliary brain metastases from papillary adenocarcinoma of the lung - unusual MRI pattern with histopathologic correlation . Pol J Radiol 2013. ; 78 ( 3 ): 57 – 60 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Santos Vázquez G , Garcia Cázarez R , Moreno Pizarro E , Serrano Padilla AE , Plascencia Salcedo JC. Central nervous system miliary brain metastasis secondary to breast cancer . Cureus 2020. ; 12 ( 8 ): e9649 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Koyyala VPB , Goyal S , Jajodia A , et al . Miliary brain metastasis-a rare pattern of metastases from breast cancer . South Asian J Cancer 2020. ; 9 ( 3 ): 188 – 189 . [DOI] [PMC free article] [PubMed] [Google Scholar]