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A. HRICHI, S. KOUKI, M. LANDOULSI ,R. AOUINI, I. GANZOUI,
S.BOUGUERRA, Y. AROUS, H. BOUJEMAA, N. BEN ABDALLAH
Radiology service, Main Military hospital of Instruction of Tunis, Tunisia
CH7
Inroduction:
Several diseases can present with multi-cystic
brain lesions:
 True cysts
 Abscess formations
 Cysticercosis
 Fungal infections
 Cerebral tumors
 Metastases…
Radiologist role?
1- Positive diagnosis
easy!
2- Approach of etiologic
diagnosis:
the main question!
Case report:
A rare case of cystic
intracerebral metastases from
adenocarcinoma of the lung
♂
49 years old
 No medical histories
 Smoking patient
 Presented with progressive dizziness
and equilibrium disorders that had
developed for 5 days.

Neurological examination:
cerebellar syndrome
 no other focal signs

Biology:
 Lymphocytes:  ↓
 Alkaline phosphatase: ↑
 Other laboratory studies: normal
CT brain Scan was indicated
Imaging findings:
a1
b1
a2
b2
CT brain scan without(a) and with(b) injection of iodinated contrast:
multifocal hypodense lesions(a) with partial peripheral contrast
enhancement(b) but without significant perifocal oedema.
Further brain MRI was performed and
allowed to objectify:
multifocal cystic lesions with partial
peripheral contrast enhancement but
without significant perifocal oedema.
a1
a2
a3
b1
b2
b3
Axial T1-weighted
with (a1, a2, a3)
and without
gadolinium (b1,
b2, b3): nodular
hypointense
multiple extraaxial lesions, with
partial peripheral
contrast
enhancement.
a1
a2
a3
b1
b2
b3
Axial T2weighted (a1,
a2, a3) and
FLAIR (b1, b2,
b3): Multiple
hyper-T2 hypoFLAIR extraaxial lesions
(cystic lesions).
a1
a2
a3
b1
b2
b3
axial diffusion
(a1, a2, a3) and
ADC (b1, b2,
b3):
Multiples
nodular lesions
hyperin tense in
diffusion with a
low ADC.
In total:
♂
49 years old
 No medical histories
 Smoking patient
 Lc ↓ , PAL ↑
 multi-cystic brain lesions (CT – MRI)
????

In total:
♂
49 years old
 No medical histories
 Smoking patient
 Lc ↓ , PAL ↑
 multi-cystic brain lesions (CT – MRI)
???

In total:
♂
49 years old
 No medical histories
 Smoking patient
 Lc ↓ , PAL ↑
 multi-cystic brain lesions (CT – MRI)
??

In total:
♂
49 years old
 No medical histories
 Smoking patient
 Lc ↓ , PAL ↑
 multi-cystic brain lesions (CT – MRI)
?

In total:
♂
49 years old
 No medical histories
 Smoking patient
 Lc ↓ , PAL ↑
 multi-cystic brain lesions (CT – MRI)

Lung cancer?

a CT-chest-scan revealed a lungular
small nodule not exceeding 12mm of
main line with no other secondary
locations

Stereotaxic brain biopsy confirmed a
well-differentiated lung adenocarcinoma
Discussion:
Brain lesions in patients with known malignancies are
suspicious for metastases;
→ usually: as well-circumscribed densely enhancing
masses with surrounding vasogenic edema.

Cystic brain lesions are unusual;
→ can be misdiagnosed as: brain abscesses, primary
cerebral tumors, or parasitic infections, especially in
patients without a history of malignancy.

Cystic cerebral metastases have been
described in carcinomas of :
Thymus
 Breast
 Prostate
 Pancreas

However, and in reviewing the literature:
-We have only found 2 similar cases
reports of lung adenocarcinoma with
cystic cerebral metastases.
-In both of them, the patients were already
followed for bronchial adenocarcinoma.
- while in our case, cystic cerebral
metastases revealed the disease.
Conclusion:
This case demonstrates an unusual pattern
of cerebral metastases of a bronchial
adenocarcinoma. This constellation should
be considered in the differential diagnosis
of cerebral cystic lesions even in patients
without a history of malignancy, and wich is
necessary to evoke at every smoking
adult's of about forty. The exact nature of
which might be difficult to assess without
biopsy.
Cystic
cerebral
lesions
Age:
about
forty
No
medical
histories
♂
Check
the
lungs
smoking
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