title: Advanced neuroimaging studies in a patient with brain metastases from transitional cell carcinoma of the bladder.
abstract: OBJECTIVE
  The differential diagnosis in single or oligo-brain lesions in metastatic cancer patients remains broad. Advanced imaging studies can be employed to help refine the differential and potentially guide treatment.
  
  
  METHODS
  Case report of a 52-year-old male patient with known transitional cell carcinoma of the bladder presented with headaches, cognitive symptoms, and episodic presyncope. Brain magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and octreotide scans were performed to evaluate the underlying etiology of his symptoms.
  
  
  RESULTS
  MRI revealed two enhancing mass lesions in left temporal and left cerebellar locations. Both lesions were octreotide avid and MRS of the temporal lesion showed a single large lipid peak at 1.3 ppm, a small NAA peak, and a markedly increased choline:creatine ratio that was relatively characteristic for metastases. Pathology from surgical resection revealed transitional cell carcinoma of the bladder.
  
  
  CONCLUSIONS
  Resection of both lesions revealed metastatic transitional cell carcinoma. This is the first report of octreotide scan characteristics in a patient with transitional cell carcinoma with central nervous system (CNS) metastases. The octreotide avidity of these transitional cell CNS metastases suggests the presence of somatostatin receptors that may be considered as a potential therapeutic target.
authors.affiliation: Departments of Neurology, University of Chicago, Chicago, IL.
authors.forename: Yoon J
authors.initials: YJ
authors.lastname: Choi
authors.forename: Patrik
authors.initials: P
authors.lastname: Gabikian
authors.forename: Fang
authors.initials: F
authors.lastname: Zhu
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Appelbaum
authors.forename: Robert
authors.initials: R
authors.lastname: Wollmann
authors.forename: Rimas V
authors.initials: RV
authors.lastname: Lukas
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D001932:Brain Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000556:secondary*; D002295:Carcinoma, Transitional Cell / Q000737:chemistry / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000737:chemistry / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor; D001224:Aspartic Acid; C000179:N-acetylaspartate
keywords: Bladder cancer; magnetic resonance spectroscopy; neoplasm metastasis; nuclear radiology; receptors; somatostatin