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Table of Contents    
NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1744-1745

Adenocarcinoma Lung Presenting as Synchronous third Ventricular Metastatic Lesion


1 Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission16-Jan-2022
Date of Decision28-Jan-2022
Date of Acceptance08-Jun-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
Ananth P Abraham
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355161

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How to cite this article:
Abraham AP, Rima S, Moorthy RK. Adenocarcinoma Lung Presenting as Synchronous third Ventricular Metastatic Lesion. Neurol India 2022;70:1744-5

How to cite this URL:
Abraham AP, Rima S, Moorthy RK. Adenocarcinoma Lung Presenting as Synchronous third Ventricular Metastatic Lesion. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:1744-5. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1744/355161




Solitary metastases to the third ventricle are exceedingly rare. We report only the fourth case to date of an isolated metastasis to the third ventricle from a lung malignancy.[1],[2],[3]

A 55-year-old female patient presented with a headache for 2 years and bilateral decreased vision for 4 months. Magnetic resonance imaging (MRI) showed a well-defined 2.5 cm sized intra-third ventricular mass with heterogeneous signal intensity and intense contrast enhancement [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Computerized tomography (CT) showed no calcification [Figure 1]e. Her chest radiograph showed a suspicious left hilar opacity [Figure 1]f.
Figure 1: (a–d) Contrast-enhanced MRI showing an approximately 2.5 × 2.5 cm, well-defined, predominantly T1-weighted hypointense and T2-weighted hyperintense mass inside the third ventricle with intense enhancement on the administration of intravenous gadolinium and mild hydrocephalus. (e) Plain CT brain showing no calcification within the tumor. (f) Chest radiograph showing a hilar opacity in the left lung

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She underwent right lateral frontal supraorbital craniotomy, trans-lamina terminalis approach, and partial excision of the tumor. A firm, friable, and avascular papillary mass was found within the third ventricle that was infiltrating its walls. Histopathological examination of the tumor was consistent with metastatic adenocarcinoma and the immunoprofile was suggestive of a lung primary [Figure 2]a, [Figure 2]b, [Figure 2]c. Mutational analysis revealed an EGFR mutation in exon 19. CT thorax confirmed the presence of a tumor in the upper lobe of the left lung [Figure 2]d. She underwent whole-brain radiation therapy and was started on the tyrosine kinase inhibitor erlotinib. She responded well to treatment and the tumors in the brain and lung regressed. At 3 years' follow-up, MRI showed no lesion in the brain [Figure 3]a, [Figure 3]b. However, there was disease progression in the lungs and she was started on palliative chemotherapy.
Figure 2: (a) Hematoxylin and eosin-stained section showing complex branching papillary fronds with a fibrovascular core lined by columnar, moderately pleomorphic cells displaying nuclear stratification. (b, c) Immunohistochemistry for thyroid transcription factor (TTF-1) and Napsin-A showing diffuse strong nuclear positivity and cytoplasmic positivity, respectively (d) CT thorax done postoperatively, showing a lung mass in the left upper lobe

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Figure 3: (a) Axial and (b) coronal sections of a contrast-enhanced MRI brain done 3 years postoperatively showing no tumor

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With an increasing proportion of patients with brain metastasis being treated by neurosurgeons, the differential diagnosis of a third ventricular tumor in an adult must include metastasis.

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There are no conflicts of interest.



 
  References Top

1.
Okutan O, Solaroglu I, Kaptanoglu E, Beskonakli E. Intracranial metastasis of lung adenocarcinoma mimicking colloid cyst of the third ventricle. J Clin Neurosci 2006;13:487-9.  Back to cited text no. 1
    
2.
Hazman MN, Kasthoori JJ, Gan GC, Gnanakumar G, Patricia AC. Large solitary cystic brain metastasis mimicking colloid cyst of the third ventricle. Eur J Radiol Extra 2008;67:e45-8.  Back to cited text no. 2
    
3.
Mizoguchi T, Yano H, Suzui N, Itazu T, Morishima T, Nakayama N, et al. A case of primary lung carcinoma solitarily metastasizing to the third ventricle. Interdiscip Neurosurg 2021;24:101084.  Back to cited text no. 3
    


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