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LETTERS TO EDITOR
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 918-920

Pontine metastasis as an initial presentation of lung cancer


1 Department of Internal Medicine and Critical Care, Sanjiv Bansal Cygnus Hospital, Karnal, Haryana, India
2 Department of Medical Oncology, Government Superspeciality Hospital, Srinagar, Jammu, Jammu and Kashmir, India

Date of Web Publication23-Jul-2019

Correspondence Address:
Dr. Waseem R Dar
Department of Internal Medicine and Critical Care, Sanjiv Bansal Cygnus Hospital, Karnal, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.263179

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How to cite this article:
Dar WR, Mir MH. Pontine metastasis as an initial presentation of lung cancer. Neurol India 2019;67:918-20

How to cite this URL:
Dar WR, Mir MH. Pontine metastasis as an initial presentation of lung cancer. Neurol India [serial online] 2019 [cited 2019 Aug 24];67:918-20. Available from: http://www.neurologyindia.com/text.asp?2019/67/3/918/263179




Sir,

A 45-year old male, chronic smoker presented to us with complaints of vertiginous sensation for the past 2 weeks. This sensation had started suddenly and was not associated with any nausea, vomiting, cervical pain, deafness or difficulty in walking. The patient had initially ignored it as cervical spondylosis but persistence of vertigo forced him to seek medical attention. His vital parameters, general physical, and systemic examinations were normal. A noncontrast CT scan of the head showed a mass lesion in the pons suggestive of metastasis [Figure 1]. Further workup for cancer was carried out. X-ray chest showed a right hilar mass lesion, which was confirmed on contrast enhanced computed tomography (CECT) chest [Figure 2] and [Figure 3]. Bronchoscopic biopsy of the lung mass showed features of small cell lung cancer (SCLC). His CECT abdomen showed multiple liver and right adrenal metastases. The bone scan was normal. The patient received 10 Gy of external beam radiotherapy to the brain and was started on chemotherapy with cisplatin and etoposide. Till date, the patient has received two cycles of chemotherapy and has marked symptomatic improvement.
Figure 1: NCCT brain showing pontine metastasis

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Figure 2: X-ray chest showing the lung mass

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Figure 3: CT chest showing the lung mass

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Small cell lung cancer comprises about 20% of all lung cancers.[1] About 10% patients have brain metastases at the time of establishment of diagnosis.[2],[3] Most of the brain metastasis arise usually at the junction of gray and white matter of the brain and the most common symptoms include headache, focal weakness, mental disturbances, gait ataxia, seizures, speech difficulty, visual disturbances, sensory disturbances, and limb ataxia. Brain stem metastasis occurs very rarely in lung cancer, pons being the most frequent site in such cases.[4] Vara-Castrodeza et al., reported a male patient who presented with progressive dysphagia 15 months after the diagnosis of small cell lung carcinoma.[5] Cerebral MRI revealed a pontine lesion, probably of metastatic origin. Zachariah et al., reported a 70-year old male patient who developed progressive brain stem and cerebellar signs over a course of 7 days that progressed to death. CT and MRI had shown a pontine mass.[6] Postmortem examination showed a pontine metastasis that had spread from his undiagnosed lung cancer.

Thus, although uncommon, pontine metastasis can be a presentation of an undiagnosed lung cancer and hence should be kept as a differential diagnosis in chronic smokers presenting with nonspecific symptoms like vertigo, which usually is attributed to cervical spondylosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hoffman PC, Mauer AM, Vokes EE. Lung cancer. Lancet 2000;355:479-85.  Back to cited text no. 1
    
2.
Newman SJ, Hassen HH. Frequency, diagnosis, and treatment of brain metastases in 247 consecutive patients with bronchogenic carcinoma. Cancer 2000;33:492-6.  Back to cited text no. 2
    
3.
Leibel SA. Primary and metastatic brain tumors in adults. In: Leibel SA, Phillips TL, editors. Textbook of Radiation Oncology. Philadelphia: Saunders; 1998. p. 293-323.  Back to cited text no. 3
    
4.
Sengöz M, Kabalay IA, Tezcanlı E, Peker S, Pamir N. Treatment of brainstem metastases with gamma-knife radiosurgery. J Neurooncol 2013;113:33-8.  Back to cited text no. 4
    
5.
Vara-Castrodeza A, Torrego-García JC, Puertas-Álvarez JL, Mendo-González M. Pontine metastases as a cause of dysphagia in lung carcinoma. Clin Transl Oncol 2005;7:512-4.  Back to cited text no. 5
    
6.
Zachariah SB, Rodas R, Prockop LD, Humphrey EJ, Murtagh FR, Shah CP. Fatal pontine metastasis: Clinical, CT, MRI and pathological correlates. J Fla Med Assoc 1989;76:457-60.  Back to cited text no. 6
    


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