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Brain metastasis from a lung mucoepidermoid carcinoma mimicking a brain abscess.

Saito T, Ujiie H, Kadoyama S, Higa T, Shiono S, Teramoto A - Surg Neurol Int (2015)

Bottom Line: Histologically, MEC is composed of a mixture of different cell types including mucin-secreting glandular cells and squamous cells.Accordingly, we suggest that the high DWI signal can be explained by the development of intracellular and intraluminal mucin, which have a high viscosity.Further accumulation of cases with brain metastasis from MEC is needed to establish the characteristic image findings, which would lead to prompt and adequate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Tokyo Rosai Hospital, Tokyo, Japan ; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT

Background: Mucoepidermoid carcinoma (MEC) is a rare tumor of the lung that accounts for 0.1-0.2% of all pulmonary tumors. To the best of our knowledge, brain metastasis from lung MEC is rare and magnetic resonance imaging (MRI) findings of this lesion have not been documented.

Case description: We herein report the case of a 72-year-old male. MRI revealed a left parietal tumor showing ring enhancement with medium gadolinium contrast and an evident high intensity area in the nonenhanced central portion on diffusion-weighted images (DWI) mimicking a brain abscess. Histologically, MEC is composed of a mixture of different cell types including mucin-secreting glandular cells and squamous cells. Accordingly, we suggest that the high DWI signal can be explained by the development of intracellular and intraluminal mucin, which have a high viscosity.

Conclusion: Further accumulation of cases with brain metastasis from MEC is needed to establish the characteristic image findings, which would lead to prompt and adequate treatment.

No MeSH data available.


Related in: MedlinePlus

(a) Hematoxylin and eosin staining (×100). The tumor cells were predominantly arranged in sheets and small nests. The solid areas were composed of squamous epithelial (arrows), mucus-producing glandular (arrow heads) and intermediate cells. (b) PAS staining showed that the tumor had both necrotic (arrows) and solid mucin-positive areas (arrow heads) (×40). (c) PAS staining showed strong mucin positivity within the cytoplasm and intraluminal mucus (arrows) (×200). (d) Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component (×200)
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Figure 2: (a) Hematoxylin and eosin staining (×100). The tumor cells were predominantly arranged in sheets and small nests. The solid areas were composed of squamous epithelial (arrows), mucus-producing glandular (arrow heads) and intermediate cells. (b) PAS staining showed that the tumor had both necrotic (arrows) and solid mucin-positive areas (arrow heads) (×40). (c) PAS staining showed strong mucin positivity within the cytoplasm and intraluminal mucus (arrows) (×200). (d) Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component (×200)

Mentions: The patient underwent the removal surgery under general anesthesia. After left parietal craniotomy, we first made a test puncture into the mass lesion from the cortex of the left superior parietal lobule under ultrasonic guidance. We could not aspirate pus from the lesion, and thus ruled out a brain abscess. The tumor margin was demarcated, and the lesion was removed completely. The tumor was totally removed on postoperative MRI [Figure 1f]. After the operation, the patient's numbness, motor weakness, and higher brain dysfunction gradually improved. The patient underwent biopsy of the lung tumor with bronchoscopic examination 7 days after brain surgery in the Department of Respiratory Medicine. A sequence of pathological examinations of the brain and lung lesions confirmed the presence of brain metastasis arising from the right lung MEC. The tumor had both necrotic and solid growth areas. The tumor cells were predominantly arranged in sheets and smaller nests. The solid areas were composed of squamous epithelial, mucus-producing glandular and intermediate cells [Figure 2a]. Periodic acid schiff (PAS) staining revealed strong mucin positivity within the cytoplasm and intraluminal mucus [Figure 2b and c]. Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component [Figure 2d].


Brain metastasis from a lung mucoepidermoid carcinoma mimicking a brain abscess.

Saito T, Ujiie H, Kadoyama S, Higa T, Shiono S, Teramoto A - Surg Neurol Int (2015)

(a) Hematoxylin and eosin staining (×100). The tumor cells were predominantly arranged in sheets and small nests. The solid areas were composed of squamous epithelial (arrows), mucus-producing glandular (arrow heads) and intermediate cells. (b) PAS staining showed that the tumor had both necrotic (arrows) and solid mucin-positive areas (arrow heads) (×40). (c) PAS staining showed strong mucin positivity within the cytoplasm and intraluminal mucus (arrows) (×200). (d) Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component (×200)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496829&req=5

Figure 2: (a) Hematoxylin and eosin staining (×100). The tumor cells were predominantly arranged in sheets and small nests. The solid areas were composed of squamous epithelial (arrows), mucus-producing glandular (arrow heads) and intermediate cells. (b) PAS staining showed that the tumor had both necrotic (arrows) and solid mucin-positive areas (arrow heads) (×40). (c) PAS staining showed strong mucin positivity within the cytoplasm and intraluminal mucus (arrows) (×200). (d) Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component (×200)
Mentions: The patient underwent the removal surgery under general anesthesia. After left parietal craniotomy, we first made a test puncture into the mass lesion from the cortex of the left superior parietal lobule under ultrasonic guidance. We could not aspirate pus from the lesion, and thus ruled out a brain abscess. The tumor margin was demarcated, and the lesion was removed completely. The tumor was totally removed on postoperative MRI [Figure 1f]. After the operation, the patient's numbness, motor weakness, and higher brain dysfunction gradually improved. The patient underwent biopsy of the lung tumor with bronchoscopic examination 7 days after brain surgery in the Department of Respiratory Medicine. A sequence of pathological examinations of the brain and lung lesions confirmed the presence of brain metastasis arising from the right lung MEC. The tumor had both necrotic and solid growth areas. The tumor cells were predominantly arranged in sheets and smaller nests. The solid areas were composed of squamous epithelial, mucus-producing glandular and intermediate cells [Figure 2a]. Periodic acid schiff (PAS) staining revealed strong mucin positivity within the cytoplasm and intraluminal mucus [Figure 2b and c]. Immunohistochemical staining of p40 showed nuclear positivity for the squamous cell component [Figure 2d].

Bottom Line: Histologically, MEC is composed of a mixture of different cell types including mucin-secreting glandular cells and squamous cells.Accordingly, we suggest that the high DWI signal can be explained by the development of intracellular and intraluminal mucin, which have a high viscosity.Further accumulation of cases with brain metastasis from MEC is needed to establish the characteristic image findings, which would lead to prompt and adequate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Tokyo Rosai Hospital, Tokyo, Japan ; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT

Background: Mucoepidermoid carcinoma (MEC) is a rare tumor of the lung that accounts for 0.1-0.2% of all pulmonary tumors. To the best of our knowledge, brain metastasis from lung MEC is rare and magnetic resonance imaging (MRI) findings of this lesion have not been documented.

Case description: We herein report the case of a 72-year-old male. MRI revealed a left parietal tumor showing ring enhancement with medium gadolinium contrast and an evident high intensity area in the nonenhanced central portion on diffusion-weighted images (DWI) mimicking a brain abscess. Histologically, MEC is composed of a mixture of different cell types including mucin-secreting glandular cells and squamous cells. Accordingly, we suggest that the high DWI signal can be explained by the development of intracellular and intraluminal mucin, which have a high viscosity.

Conclusion: Further accumulation of cases with brain metastasis from MEC is needed to establish the characteristic image findings, which would lead to prompt and adequate treatment.

No MeSH data available.


Related in: MedlinePlus