Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1152
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (983 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Article Figures

 Article Access Statistics
    Viewed981    
    Printed47    
    Emailed0    
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal

 

  Table of Contents  
LETTER TO THE EDITOR
Year : 2017  |  Volume : 54  |  Issue : 1  |  Page : 81-82
 

Fluorodeoxyglucose-avid pulmonary mucinous adenocarcinoma presenting with nonfluorodeoxyglucose-avid cystic brain lesions of unknown etiopathology: Brain magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography-computed tomography imaging features and additional value of whole-body positron emission tomography acquisition


1 Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Prof. S Basu
Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.219578

Rights and Permissions



How to cite this article:
Shinde V, Basu S. Fluorodeoxyglucose-avid pulmonary mucinous adenocarcinoma presenting with nonfluorodeoxyglucose-avid cystic brain lesions of unknown etiopathology: Brain magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography-computed tomography imaging features and additional value of whole-body positron emission tomography acquisition. Indian J Cancer 2017;54:81-2

How to cite this URL:
Shinde V, Basu S. Fluorodeoxyglucose-avid pulmonary mucinous adenocarcinoma presenting with nonfluorodeoxyglucose-avid cystic brain lesions of unknown etiopathology: Brain magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography-computed tomography imaging features and additional value of whole-body positron emission tomography acquisition. Indian J Cancer [serial online] 2017 [cited 2020 Apr 6];54:81-2. Available from: http://www.indianjcancer.com/text.asp?2017/54/1/81/219578


Sir,

Presentation with cystic brain lesions of unknown etiology is not infrequent in developing countries. These lesions are usually diagnosed on computed tomography (CT) and magnetic resonance imaging (MRI). The differentials for the cystic lesions of the brain are quite exhaustive. The common causes in the developing countries include brain abscess, tuberculoma, neurocysticercosis, primary brain tumors, and metastases. To differentiate these cystic lesions on imaging findings alone are difficult task. Hence, a battery of imaging modalities is used to differentiate and find the probable cause of the cystic brain lesions.

A 61-year-old male presented with complaints of the right lower limb weakness of 1-month duration and headache of similar duration. MRI of the brain revealed multiple well-defined cystic lesions [Figure 1] showing cerebrospinal fluid intensity in all sequences in frontal, temporal, bilateral occipital, and right cerebellar hemisphere. Multiple tiny lesions appearing isointense to the cortex in T1-weighted images and hyperintense on T2-weighted and fluid attenuation inversion recovery images and showing minimal postcontrast enhancement were also noted both cerebral hemispheres. The differential diagnosis raised on the brain MRI included: (1) neurocysticercosis, (2) metastases, (3) hydatid cyst, (4) toxoplasmosis, (5) tuberculous abscess. In view of no or minimal postcontrast enhancement, the last two differentials were unlikely. Hydatid cyst of the brain without any other organ is very rare (occurs only in 2% of echinococcosis and is usually solitary and lies in the territory of middle cerebral artery) and multiple lesions are extremely rare to encounter. Neurocysticercosis, on the other hand, involves both intra- and extra-axially, subarachnoid space is more common than brain parenchyma usually involving gray-white matter junction and 1–2 cm in diameter and present as cystic lesions in vesicular/colloidal vesicular stage (“cyst with dot” sign) with thickened wall and surrounding edema.
Figure 1: Magnetic resonance imaging of the brain

Click here to view


Fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) was undertaken as a further aid in the diagnosis. The brain FDG-PET was undertaken along with whole-body FDG PET-CT which was performed to search for the possible cause of cystic brain lesions. The cystic brain lesion did not show any FDG uptake [Figure 2]a. On whole FDG PET-CT, a FDG-avid mass was noted in the left lower lobe lung parenchyma [Figure 2]b and [Figure 2]c. Enlarged FDG-avid paratracheal, aortopulmonary window, and prevascular lymphadenopathy were also noted. Summating the findings on the brain MRI and FDG PET-CT, the most likely diagnosis inferred was cystic brain lesions arising from a FDG-avid primary malignancy in the left lower lobe lung parenchyma and metastatic mediastinal adenopathy. CT-guided biopsy of the left lower lobe mass to confirm the diagnosis was done [Figure 3], which on histopathology revealed adenocarcinoma lung with an acinar pattern and extracellular mucin.
Figure 2: (a) Fluorodeoxyglucose-positron emission tomography/computed tomography of the brain. (b) Whole-body fluorodeoxyglucose-positron emission tomography/computed tomography. (c) Fluorodeoxyglucose-positron emission tomography/computed tomography fused coronal slices

Click here to view
Figure 3: Contrast computed tomography chest with guided biopsy

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow