Tuberc Respir Dis.  2012 Feb;72(2):182-186.

A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis

• Lee HJ
• Oh IJ
• Park SW
• Ban HJ
• Kim YC
• Kim SO

Abstract

Miliary brain metastasis from the lung is uncommon and has a poor therapeutic response. We report a case of pulmonary adenocarcinoma combined with multiple brain cystic lesions that were initially misdiagnosed as neurocysticercosis. A 53-year-old male who never smoked was admitted to our hospital with complaints of agitation and cognitive impairment. Brain magnetic resonance imaging showed innumerable, small nodular lesions with a central, low signal intensity in whole brain parenchyma. His symptoms were not improved by the empirical praziquantel medication for disseminated neurocysticercosis. After a transbronchial biopsy from the right middle lobe, we could diagnose the primary lung adenocarcinoma with a single nucleotide polymorphism in the epidermal growth factor receptor exon 20 at codon 787 (Q787Q). His neurologic symptoms and imaging findings have been gradually improving with a first-line Gefitinib treatment for five months. We recommend a more active diagnostic approach including biopsy in case of atypical imaging findings.

Keyword

Neurocysticercosis; Neoplasm Metastasis; Brain; Gefitinib

MeSH Terms

Adenocarcinoma
Biopsy
Brain
Codon
Dihydroergotamine
Exons
Humans
Lung
Lung Neoplasms
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Metastasis
Neurocysticercosis
Neurologic Manifestations
Polymorphism, Single Nucleotide
Praziquantel
Quinazolines
Receptor, Epidermal Growth Factor
Smoke
Adenocarcinoma
Codon
Dihydroergotamine
Lung Neoplasms
Praziquantel
Quinazolines
Receptor, Epidermal Growth Factor
Smoke

Figure

• 

  Figure 1 The initial chest X-ray shows multiple miliary nodular lesions in the lower right lung fields. (B) After 1 month of the gefitinib treatment, the lesions are remarkably improved on X-ray. (C) Chest CT shows irregular nodular interstitial thickenings and consolidations combined with innumerable tiny nodules in the right middle and lower lobes. (D) After 1 month of the gefitinib treatment, the lesions are remarkably improved on CT scan. CT: computed tomography.

• 

  Figure 2 (A) The initial brain MRI of an outside hospital shows multiple cystic lesions with tiny scattered calcified nodules. (B) After 4 months, a follow-up MRI shows innumerable, small nodular lesions (up to 1.6 cm) with a central, low signal intensity in the whole brain parenchyma, suggestive of disseminated neurocysticercosis at the vesicular stage. (C) The cystic and nodular lesions are improved by a gefitinib treatment for 1 month. (D) The cystic and nodular lesions are improved by a gefitinib treatment for 5 months. MRI: magnetic resonance imaging.

• 

  Figure 3 Direct sequencing showing the mutation found in the kinase domain of EGFR-2361G>A transition in exon 20, but this did not alter the final amino acids of glutamine at codon 787 (Q787Q). EGFR: epidermal growth factor receptor.

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