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| CASE REPORT |
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| Year : 2023 | Volume
: 13
| Issue : 1 | Page : 43-44 |
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A clinical case report on intraventricular metastatic from a lung primary
Arnabjyoti Deva Sarma1, Moitrayee Devi2, Jibon Sharma3
1 Department of Radiology, Faculty of Paramedical Science, Assam Downtown University, Guwahati, Assam, India
2 Department of Microbiology, Faculty of Science, Assam Downtown University, Guwahati, Assam, India
3 Department of Oncology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| Date of Submission | 01-Sep-2021 |
| Date of Decision | 13-Dec-2022 |
| Date of Acceptance | 15-Feb-2023 |
| Date of Web Publication | 24-Feb-2023 |
Correspondence Address:
Arnabjyoti Deva Sarma
Assistant Professor, Department of Radiology, Faculty of Paramedical Science, Assam Down Town University, Guwahati, Assam
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/cmrp.cmrp_89_21
Intraventricular metastasis is very often carries a poor outcome. Here may be the case of a 55-year-old farmer presented to us with headache, vomiting and gradual deterioration in vision. Imaging studies revealed a heterogeneously enhancing lesion within the ventricle. Intraoperatively, highly vascular intraventricular lesion arising from Plexus Choroideus was found. Histopathology revealed metastatic lesion from epithelial metastasis. High-resolution computed tomography of the lung revealed a little lesion within the left apex of the lung. The patient recovered well and was referred for radiotherapy.
Keywords: Intraventricular, lung primary, metastasis, oncology, radiology
How to cite this article:
Sarma AD, Devi M, Sharma J. A clinical case report on intraventricular metastatic from a lung primary. Curr Med Res Pract 2023;13:43-4 |
| Introduction | |  |
Brain metastases can be representing as huge sources of morbidity and mortality in patients with systemic cancer. They are neoplasm which spread to the brain secondarily and subsequently originate in the outside tissues of the central nervous system. In adults, this kind of metastases is found to be away from the foremost common intracranial tumours. Their incidence seems to be rising as systemic cancer therapies have improved and thereby extending patients' lives. The most common intraventricular lesions such as colloid cyst, choroid plexus papilloma, intraventricular gliomas (septal) and subependymal giant cell astrocytoma are seen in adults. Intraventricular metastasis may be a rare existence, with the most typical primary site of being lung carcinoma. The main modality of treatment is only surgical resection. Due to deep location and complicated vascular anatomy in the region, surgery for these lesions is very difficult as compared to other parenchyma metastases. In this case study, we reported a solitary intraventricular metastasis resembling a meningioma.[1],[2]
| Case Report | | |
A 55-year-old farmer presented with complaints of headache and vomiting. There were no significant of metastatic signs of liver, lungs or bones. Except for right temporal field, defects on visual charting rest of the neurological examination was normal. MRI brain with contrast showed isodense to hypodense lesion in the right posterior parietal region with Intraventricular extension on T1W images with good post-contrast enhancement. There was significant oedema on FLAIR images. Computed tomography (CT) of the brain with contrast showed a ring-enhancing lesion with significant perilesional oedema in the right posterior-parietal and temporal region with intraventricular extension. Rest investigation including chest radiograph was normal. Right parietooccipital craniotomy was done. On opening the dura, corticotomy was done posterior and inferior to sensory cortex. The tumour was seen attached to the choroid plexus of occipital horn. The tumour was very vascular; reddish in colour, complete excision of the lesion was achieved. The patient improved with minimal improvement in vision postoperatively. Histopathological examination revealed metastatic carcinoma composed of epithelial cells with high mitotic index. The patient was re-evaluated and high-resolution computed tomography of the lungs showed a lesion (although chest x-ray done pre-operatively was apparently normal) on the right side. CT-guided biopsy of the lesion was suggestive of squamous cell carcinoma. The patient was advised radiotherapy and chemotherapy at specialised centres.
| Discussion | | |
The most common intracranial growth is brain metastasis. Carcinoma is that the typical supply of brain metastasis in adult men, on the other hand, malignant neoplastic disease is that the most common supply in ladies. Adenocarcinoma glandular cancer glandular malignant neoplastic disease carcinoma of the respiratory organ is additionally possible to distribute than squamous cell carcinoma and 45% measure solitary.[2] The ventricular tumours are arises from the walls of the ventricle or tissues at an intervals and throughout the ventricle, especially the plexus, septum pellucidum and neural structure. Most of the tumours are measuring low grade and slow growing which has astrocytoma, oligodendroglioma, rate non-malignant neoplasm, etc. Few of them are extremely malignant like malignant ependymoma and plexus malignant neoplastic disease. Initially, cavity metastases occur at intervals in the ventricle of the brain, although parenchyma metastasis that reaches up to the ventricle square measure the proliferation of aberrant tissue deposits in tissue layer carcinomatosis and should not be classified as cavity metastasis. This comprises 0.9% of all types of brain metastasis. Single cavity in ventricle (IV) metastasis has been found in 0.14% of cases. Within the ventricle conjointly, it is the region of trigone that remained the foremost typical website, probably because of the high property of the plexus. Maximum of that patient gift with options of non-localised raised intracranial pressure such as headache, vomit and altered sensorium.[1] Surgical excision, actinotherapy and radiosurgery square measure the sole treatment choices offered. Surgery seems to be higher to actinotherapy in brain metastasis and thanks to the pace with that the lesion is removed, ability to induce tissue for histopathological identification, speedy overcome of symptoms and specific quality treatment counting in growth microscopic anatomy. Surgery has sure benefits over different treatment. First, full excision of a pathological process lesion provides palliation now eliminating by the implications of enhanced intracranial pressures and thus the direct irritation of close brain tissue. Second, surgery provides tissue to verify the identification of metastasis. Surgery will provide a primary cure if all of the growth cells are properly eliminated. These benefits should be weighed against the requisite propensity of an introduced of surgery, that patients to potential intraoperatively, surgical issues, together with harm, wound infection, pulmonic emboli, infarct and sepsis. Patients with single brain metastases square measure the foremost acceptable surgical candidates.[2],[3] Initially, symptomatic brain metastases patients are introduced with long duration corticosteroids for the treatment, with the target of decreasing the oedema surrounded by tumours and serving to revive medical speciality operate. General therapy is not appropriate against the foremost common kinds of primary tumours, that tend to be chemo-resistant; but, it seems to be a helpful addition to different therapies. The main instruments at intervals in the clinician's array against brain metastases embrace whole-brain actinotherapy, open surgical operation and stereotactic radiosurgery.[2],[3] The patient had one lesion mimicking tumour and later was tested to be a metastasis type of respiratory organ primary.
| Conclusion | | |
Metastasis should be considered in the differential diagnosis for patients presenting a single intraventricular lesion as it is the most common intracranial space-occupying lesion.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Kumar R, Wani AA, Reddy S, Sahu R. An unusual presentation of intracranial metastasis. Int J Neurosurg 2009;5:68-74 [Doi: 10.5580/2481].  |
| 2. | Frederick Lang F, Eric Chang L, Suki D, David Wildrick M, Sawaya R, Winn HR. Youmans. Neurological Surgery. 6 th ed. Elseiver: Ch.130, 2011. p. 1410-25. |
| 3. | Sarma AD, Devi M. A comparative evaluation of USG and MRCP in patients of obstructive jaundice and assess their role as a useful diagnostic tool and correlate the USG and MRCP findings with operative/FNAC/histopathological/ERCP findings/therapeutic follow up wherever performed. J Emerg Technol Innov Res 2019;6:213-34. |
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