A RNM apresentava critérios diagnósticos para neurocisticercose. Como não apresentou melhora com tratamento clínico, optou-se pela exérese das lesões. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL · PubMed Central. Mendoza-Ticona, Alberto. Existe evidencia suficiente para declarar a. Request PDF on ResearchGate | On Oct 1, , F. Arméstar and others published Coma secundario a neurocisticercosis: estudio de 4 casos.
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Cystic brain metastases radiologically simulating neurocysticercosis. Brain metastases are common complications of cancer. Magnetic resonance imaging MRIthe main diagnostic imaging method in these cases, rarely shows cystic images.
The patient was a year-old woman who had had severe headache for a month that was refractory to medication, and had previously had breast cancer, which had been treated. The MRI showed the criteria for neurocysticercosis. Since there was no improvement with clinical treatment, we chose to excise the lesions.
Neudocisticercosis analysis showed an epithelioid malignant neoplasm. From immunohistochemical analysis, it was concluded that this was a metastasis of breast carcinoma.
Even when the MRI is not characteristic of cerebral metastasis, this hypothesis needs to be ruled out in patients with a previous history of cancer. Brain metastases are common complications of cancer, and show increasing incidence.
They may present idagnosticos as headache, seizures or loss of cognitive or motor function depending on the location of the lesions. Magnetic resonance imaging MRI is the main diagnostic imaging method.
Cystic brain metastases radiologically simulating neurocysticercosis
However, metastases rarely show multiple cystic images on MRI. The World Health Organization WHO considers that neurocysticercosis is the commonest parasitic disease of the brain; its main manifestation is seizure. The seropositivity reaction rate in Brazil is 2.
We report an unusual case of cystic brain lesions with a radiological diagnosis of neurocysticercosis, but a pathological diagnosis of brain metastases. This case shows the importance of valuing the patient’s clinical history in the differential diagnosis of multiple brain lesions.
She had a history of breast cancer that had been treated with radiotherapy three years before the time of the admission described here. Computed tomography CT showed several hypodense lesions in cerebral parenchyma. MRI showed cystic lesions with an internal nodular structure that was similar to a scolex, thus suggesting the diagnosis of neurocysticercosis.
The lesions also had contrast enhancement on the periphery of the cyst that was more intense in the region of mural nodules Figure 1. The patient was treated with albendazole for five days, but without improvement. She then underwent surgery to resect the lesions Figure 2A. The pathological examination revealed an epithelioid malignant neoplasm Figure 2B. From this, the conclusion was a diagnosis of metastatic breast cancer.
The patient underwent radiotherapy, but without improvement.
She was admitted to the hospital sometimes with severe headache and vomiting and cerebral edema, but missed the follow-up after one year. Their histopathological spectrum is broad, and differentiation of these cysts on the basis of imaging findings alone can be problematic.
Neurocysticercosis is the most common parasitic disease of the central nervous system CNS and should be considered to be a differential diagnosis of brain metastases, especially in patients in endemic countries, because criterips the similarity of clinical manifestations.
Edema and contrast enhancement are rare. A mural nodule is often present that represents the viable larval scolex, i. One clue in this case could be the contrast enhancement around all the lesions, which is not seen in neurocysticercosis but occurs in brain metastases. Even in countries where neurocistecercosis is endemic and MRI abnormalities were suggestive of scolex, brain metastasis must be ruled out in the presence of contrast enhancement around the lesions, especially in patients with previous history of cancer.
Establishing the diagnosis of a brain diabnosticos is not always a straightforward process. Primary brain tumors are rarely multiple.
Pilocytic astrocytoma, ganglion cell tumors, ependymomas, hemangioblastomas and pleomorphic xanthoastrocytoma diagnosticls some of the primary brain tumors that can be cystic. Of these, hemangioblastomas may be epithelioid.
Current Consensus Guidelines for Treatment of Neurocysticercosis
To determine whether a tumor is primary or not, and the primary site of metastatic tumors, immunohistochemical analysis can be used, with specific markers for each tissue and cell. Metastatic adenocarcinoma of unknown primary site is a common clinical jeurocisticercosis. The use of cytokeratin 20 CK20 and 7 CK7 can assist in identifying primary sites in this situation.
CK20 positivity indicates only adenocarcinoma metastasis of many organs. Neuroocisticercosis negativity is consistent with metastatic adenocarcinoma of the lung, ovaries, liver or serous membranes.
Astrocytic neoplasms and hemangioblastomas neoplasms of vascular origin do neuocisticercosis test positive for cytokeratin epithelial cell marker. Negativity for the TTF-1 marker rules out the possibility of thyroid and primary neuroendocrine lung tumor as the primary site.
Cytokeratin 7 positivity and cytokeratin 20 negativity promote the breast as the primary site. Negativity for estrogen receptors does not rule out this possibility, since many breast tumors are not positive for hormonal receptors, 15 as occurred in this case. In brain metastases, intracranial hypertension and motor deficits are common. In these cases, examination of cerebrospinal fluid CSF may be more effective.
The survival with a single brain metastasis is longer than with multiple brain metastases, and hence the treatment in such cases consists of immediate surgery, when feasible, and optimal adjuvant therapy.
Distinguishing non-neoplastic causes from neoplastic lesions is extremely important, because misdiagnosis can lead to unwarranted neurosurgery and exposure to toxic chemotherapy or potentially harmful brain irradiation. Diligent clinical evaluation and a battery of tests are required, for a definitive diagnosis to be made. Even in cases in which MRI is not characteristic of cerebral metastasis, this hypothesis needs to be excluded when there is no improvement with clinical treatment and in patients with a previous history of cancer, especially breast cancer, which is a common cause of brain metastasis.
Atlas of tumor pathology. Tumors of the central nervous system. American Registry of Pathology; Top Magn Reson Imaging. Surgical treatment of cerebral cysticercosis: Role of diffusion-weighted imaging crjterios in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions.
J Comput Assist Tomogr. Co-existence of dual intracranial pathology clinical relevance of proton MRS. Multiple ring-enhancing lesions of the brain. Pitfalls in the diagnosis of brain tumours. Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch Pathol Lab Med.
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Cytokeratins 20 and 7 as biomarkers: Metastatic breast cancer masquerading as gastrointestinal primary. Diagnozticos nervous system metastases from breast carcinoma.
A clinical and laboratorial study in 47 patients. Multiple brain metastases from malignant thymoma. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: Differential diagnosis of intracranial ring enhancing cystic mass lesions–role of diffusion-weighted imaging DWI and diffusion-tensor imaging DTI.
Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesion. Date of first submission: September 16, Last received: December 9, Accepted: February 21, Sources of funding: None Conflict of interest: All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal.
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