title: Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report.
abstract: BACKGROUND
  Miliary brain metastasis is an extremely rare form of brain metastasis which can present with atypical imaging findings. We report the case of a patient with miliary brain metastasis of lung cancer showing calcification in metastatic lesions.
  
  
  METHODS
  A 68-year-old Japanese woman was diagnosed with lung adenocarcinoma. Brain computed tomography revealed multiple small calcified lesions in both cerebral hemispheres. Mutation of the epidermal growth factor receptor gene (exon 21, L858R) in lung cancer cells was detected, and treatment with gefitinib was initiated. A partial response was observed; however, the patient was readmitted to our hospital because of regrowth of the primary lesion and complaints of nausea, headache, and difficulty walking. Brain magnetic resonance imaging revealed scattered tiny nodules enhanced by gadolinium. A diagnosis of leptomeningeal carcinomatosis was made on the basis of cerebrospinal fluid cytology. The patient's general status worsened, and she died 356 days after the day of first medical examination. Upon autopsy, the brain was found to be edematous and swollen. Lung carcinoma cells were diffusely disseminated on the meningeal surface. Metastatic foci of small nodular form, accompanied by calcifications, were also found in the brain parenchyma. We diagnosed miliary metastasis of lung carcinoma.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the third report of calcified miliary brain metastasis confirmed by autopsy. We describe calcified lesions that increased in size during the clinical course of nine months. Brain computed tomography findings that reveal multiple small calcified lesions in patients with malignancy should raise suspicion of miliary brain metastasis.
authors.affiliation: First Department of Internal Medicine, University of Toyama, Toyama City, 930-0194, Japan. htaro-tym@umin.ac.jp.
authors.forename: Minehiko
authors.initials: M
authors.lastname: Inomata
authors.forename: Ryuji
authors.initials: R
authors.lastname: Hayashi
authors.forename: Kenta
authors.initials: K
authors.lastname: Kambara
authors.forename: Seisuke
authors.initials: S
authors.lastname: Okazawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Imanishi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Kensuke
authors.initials: K
authors.lastname: Suzuki
authors.forename: Toru
authors.initials: T
authors.lastname: Yamada
authors.forename: Toshiro
authors.initials: T
authors.lastname: Miwa
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kashii
authors.forename: Shoko
authors.initials: S
authors.lastname: Matsui
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Tobe
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Sasahara