A 64-Year-Old Man Unable to Lift His Arm or Walk

Winston Tan, MD; Nicole Ganon, PA; Ashton Ritter, MMS

Disclosures

May 21, 2019

Discussion

The CT findings of a mass with associated edema, along with his history of lung cancer, strongly suggested brain metastasis (Figure 1).

Figure 1.

In this case, a solitary metastasis must be differentiated from a primary central nervous system neoplasm. MRI of the head revealed the following:

Figure 2.

Brain metastasis is one of the most significant complications of lung cancer and represents the most common brain tumor in adults. The incidence of brain metastasis is rising with the increase in survival of patients with cancer. MRI with contrast enhancement is currently the procedure of choice because it is more sensitive and specific than other imaging modalities in determining the presence, location, and number of metastases.[1] However, contrast-enhanced CT is widely used because of its accessibility and low cost.

Lung cancer is the leading cause of cancer-related mortality in men and women.[2] In 2018, 154,050 lung cancer-related deaths were estimated in the United States.[3] Most lung cancers are classified as either small-cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). Of the two, NSCLC is the most common form and accounts for approximately 85% of lung cancer cases. Histologic classification of NSCLC is further classified into adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Classification of lung cancer by histopathologic subtype is important because it provides information about prognosis and guides treatment decisions.

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