Fatal pontine metastasis: clinical, CT, MRI and pathological correlates.
Progressive brainstem and cerebellar signs developed in a previously healthy 70-year-old man over a course of seven days. A pontine mass characterized by CT and MRI suggested an infiltrating primary pontine glioma. Gross postmortem examination showed a medullary-pontine hemorrhage. Microscopic analysis disclosed an undifferentiated large cell carcinoma which was found to originate from the lung. Differential diagnoses in cases of suspected brainstem lesions are given, including metastatic tumors which are rare when presenting as a solitary brainstem mass. Optimal patient management should be formulated on the basis of histopathological diagnosis rather than imprecise imaging data. Exact tissue diagnosis will also avoid an extensive and expensive search for an occult systemic cancer. The roles of radiation, chemotherapy and surgery are also discussed.
Zachariah
S B
SB
Rodas
R
R
Prockop
L D
LD
Humphrey
E J
EJ
Murtagh
F R
FR
Shah
C P
CP
D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D005910:Glioma / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011149:Pons; D014057:Tomography, X-Ray Computed / Q000379:methods*