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Year : 2004  |  Volume : 52  |  Issue : 1  |  Page : 136

Cyst with a mural nodule: Unusual case of brain metastasis

Department of Neurosurgery, AIIMS, New Delhi

Correspondence Address:
Department of Neurosurgery, AIIMS, New Delhi
[email protected]

How to cite this article:
Garg A, Suri A, Gupta V. Cyst with a mural nodule: Unusual case of brain metastasis. Neurol India 2004;52:136

How to cite this URL:
Garg A, Suri A, Gupta V. Cyst with a mural nodule: Unusual case of brain metastasis. Neurol India [serial online] 2004 [cited 2021 Dec 8];52:136. Available from:

A 34-year-old woman presented with history of headaches, vomiting and progressive left hemiparesis for the last 3 months. CECT showed right frontal juxtaventricular, cystic lesion with an enhancing mural nodule and focal wall [Figure:1a]. On MRI, the cyst was hypointense on T1WI [Figure:1b] and hyperintense onT2WI [Figure:1c and suppressed on FLAIR sequence [Figure:1d]. Per-operatively, a cyst with yellowish clear fluid and a small grayish, solid part were removed. The cyst walls were not necrotic. HPE revealed a malignant tumor composed of cells with focal areas of glandular differentiation with marked pleomorphism. The tumor cells were immunoreactive for cytokeratin and mucin. The wall of the cyst showed gliosis. A diagnosis of metastatic adenocarcinoma was made. No primary could be localized.
The radiological differential considerations for a cystic tumor with an enhancing mural nodule include pilocytic astrocytoma, hemangioblastoma, pleomorphic xanthoastryocytoma, meningioma and ganglioglioma.[1],[2] The radiological finding of a cystic tumor with a mural nodule had not been described previously in brain metastases. The presence of minimal edema relative to the size of the lesion in our case was also unusual for a metastatic deposit. FLAIR sequences have been reported to be useful in distinguishing between cystic neoplastic and non-neoplastic lesions.[3] The cyst had suppression of signal intensity on FLAIR imaging, thereby suggesting non-mitotic pathology. This unusual appearance is possibly attributed to the lack of proteinaceous or myxoid material inside the cyst, which is rare in metastasis. Therefore, FLAIR images should be interpreted with caution. 

     References Top

1.Maiuri F. Cysts with mural nodules in the cerebral hemispheres. Neurosurgery 1988;22:703-6.  Back to cited text no. 1  [PUBMED]  
2.Tomita T, McLone DG, Naidich TP. Mural tumors with cysts in the cerebral hemisphere in children. Neurosurgery 1986;19:998-1005.  Back to cited text no. 2    
3.Aprile I, Iaiza F, Lavaroni A, Budai R, Dolso P, Scott CA, et al. Analysis of cystic intracranial lesions performed with Fluid-Attenuated Inversion   Back to cited text no. 3    
4.Recovery MR imaging. AJNR Am J Neuroradiol 1999;20:1259-67.  Back to cited text no. 4    


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Online since 20th March '04
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