Skip to main content

Advertisement

Log in

Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Miliary dissemination is a rare form of brain metastasis. The clinical and pathologic features of this form are unclear.

Methods

We report a 66-year-old man with miliary brain metastases from adenocarcinoma of the lung, describing MRI and neuropathologic findings in the context of previously reported cases.

Results

Initial disorientation progressed to an apallic state within 6 months. Although, CT with administration of contrast agent failed to demonstrate any lesions, MRI with Gd-DTPA administration showed multiple enhancing miliary nodules in the cerebral cortex, basal ganglia, thalamus, cerebellum, and brainstem. Some of those nodules also could be seen on T2-weighted imaging without Gd-DTPA, but were difficult to identify conclusively. A histopathologic examination at autopsy disclosed diffusely distributed miliary tumor nodules in a perivascular distribution without surrounding focal edema or reactive gliosis. Notably, this patient with miliary brain metastases developed disorientation followed by unconsciousness, which overshadowed other focal neurologic signs at that time.

Conclusion

We should consider this pattern of brain dissemination when a cancer is associated with unexplained disturbance of consciousness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Madow L, Alpers BJ (1951) Encephalic form of metastatic carcinoma. Arch Neurol 65:161–173

    CAS  Google Scholar 

  2. Fukuda Y, Homma T, Kohga H, Uki J, Shisa H (1988) A lung cancer case with numerous calcified metastatic nodules of the brain. Neuroradiology 30:265–268

    Article  PubMed  CAS  Google Scholar 

  3. Ara Callizo JR, Gimenez-Mas JA, Martin J, Lacasa J (1989) Calcified brain metastases from acinar-cell carcinoma of pancreas. Neuroradiology 31:200

    Article  PubMed  CAS  Google Scholar 

  4. Nemzek W, Poirier V, Salamat MS, Yu T (1992) Carcinomatous encephalitis (miliary metastases): lack of contrast enhancement. AJNR Am J Neuroradiol 14:540–542

    Google Scholar 

  5. Shirai H, Imai S, Kajihara Y, et al (1997) MRI in carcinomatous encephalitis. Neuroradiology 39:437–440

    Article  PubMed  CAS  Google Scholar 

  6. Nakamura H, Toyama M, Uezu K, Nakamoto A, Toda T, Saito A (2001) Diagnostic dilemmas in oncology. Case 1. Lung cancer with miliary brain metastases undetected by imaging studies. J Clin Oncol 19:4240–4241

    Google Scholar 

  7. Rivas E, Sanchez-Herrero J, Alonso M (2005) Miliary brain metastases presenting as rapidly progressive dementia. Neuropathology 25:153–158

    Article  PubMed  Google Scholar 

  8. Olsen WL, Winkler LM, Ross DA (1987) Carcinomatous encephalitis: CT and MR findings. AJNR Am J Neuroradiol 8:553–554

    PubMed  CAS  Google Scholar 

  9. Floeter MK, So YT, Ross DA, Greenberg D (1987) Miliary metastasis to the brain: clinical and radiologic features. Neurology 37:1817–1818

    PubMed  CAS  Google Scholar 

  10. Yamazaki T, Harigaya Y, Noguchi O, Okamoto K, Hirai S (1993) Calcified miliary brain metastases with mitochondrial inclusion bodies. J Neurol Neurosurg Psychiatry 56:110–111

    Article  PubMed  CAS  Google Scholar 

  11. Bhushan C (1997) “Miliary” metastatic tumors in the brain. J Neurosurg 86:564–566

    Article  PubMed  CAS  Google Scholar 

  12. Sawamura Y, Murata J, Tashiro K (2000) Miliary brain metastases (in Japanese with no English abstract). Shinkeinaika 53 [Suppl 2]:2–3

    Google Scholar 

  13. Nishimura H, Nishimura T, Tachibana H, Sugita M (2000) A case with miliary metastatic brain tumor (in Japanese with English abstract). Shinkeinaika 53:173–174

    Google Scholar 

  14. Hwang TL, Close TP, Grego JM, Brannon WL, Gonzales F (1996) Predilection of brain metastasis in gray and white matter junction and vascular border zones. Cancer 77:1551–1555

    Article  PubMed  CAS  Google Scholar 

  15. Posner JB, Chernik NL (1978) Intracranial metastases from systemic cancer. Adv Neurol 19:579–592

    PubMed  CAS  Google Scholar 

  16. Takakura K, Sano K, Hojo S, Hirano A (1892) Metastatic tumors of the central nervous system. Igaku-Shoin, Tokyo

Download references

Acknowledgement

We are grateful to Dr Koichiro Sakai at Kanazawa Medical University for the analysis of the antineuronal antibodies.

Conflict of interest statement

We declare that there is no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yohei Iguchi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iguchi, Y., Mano, K., Goto, Y. et al. Miliary brain metastases from adenocarcinoma of the lung: MR imaging findings with clinical and post-mortem histopathologic correlation. Neuroradiology 49, 35–39 (2007). https://doi.org/10.1007/s00234-006-0152-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-006-0152-6

Keywords

Navigation