title: Abscess formation within a cerebellar metastasis: Case report and literature review.
abstract: BACKGROUND
  The managements of brain abscesses and brain tumors including brain metastases differ greatly, especially in terms of surgical procedures. Therefore, differentiating between the two is essential for assuring optimal treatment. However, on rare occasion, these two lesions coexist. Only five cases with both a brain tumor and an abscess have thus, far been reported. We experienced a patient with a brain abscess within a cerebellar metastasis.
  
  
  METHODS
  A middle-aged man receiving treatment for bile duct cancer presented with headache and nausea. Computed tomography (CT) and magnetic resonance (MR) imaging revealed two lesions, one in each cerebellar hemisphere. Although these lesions appeared to be brain metastases, the right lesion showed high intensity on diffusion-weighted images (DWI), and magnetic resonance spectroscopy (MRS) findings suggested an abscess. Surgical puncture of the lesion identified it as a brain abscess histologically, and we thus, administered antibiotics. However, since the lesion grew, we performed a second surgery for removal, which histopathologically the lesion to be a well-differentiated adenocarcinoma. The final diagnosis was an abscess within a cerebellar metastasis.
  
  
  CONCLUSIONS
  Modern diagnostic tools such as DWI and MRS are reportedly reliable for differentiating brain tumors from brain abscesses, though they are not specific in cases with both lesions. The present case highlights the importance of considering coexisting diseases prior to surgery when we encounter a lesion which has the imaging characteristics of both a tumor and an abscess. The patient may have a better outcome if, preoperatively, surgeons take into consideration the possibility of the coexistence of a brain tumor and a brain abscess.
authors: Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. Electronic address: yoursongmysong@hotmail.com.
authors: Yukihiro
authors: Y
authors: Goto
authors: Department of Neurosurgery, Nantan General Hospital Yagi-cho, Yagiueno 25, Nantan-city, Kyoto 629-0197, Japan.
authors: Toshihiko
authors: T
authors: Ebisu
authors: Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors: Katsuyoshi
authors: K
authors: Mineura
keywords: Brain abscess; Brain metastasis; Cerebellar metastasis; Intratumoral abscess