Neurology: Case of the Month

Which of the following radiographic abnormalities would be MOST suspicious for brain metastasis?

[ A ] A 1.5 cm, cystic, thin-walled lesion on the border of the Sylvian fissure, with several scattered punctate calcifications located near cortical sulci, and a smaller, 0.5 cm cystic lesion attached to the surface of the pons.
[ B ] A solitary, ill-defined, inhomogeneously enhancing mass located deep within the parenchyma of the frontal lobe, with surrounding edema.
[ C ] A solitary, well-circumscribed, 1.5 cm, extra-axial lesion located at the surface of the sphenoid ridge, which enhances homogeneously.
[ D ] A single, well-defined, 2 cm intraparenchymal mass located near the gray-white junction, with a pronounced hemorrhagic component and mild surrounding edema.

What are the MOST common primary sources for brain metastasis in the general population?

What is the MOST sensitive technique for detection of brain metastasis?

What is the median survival of untreated brain metastasis patients?

Which of the following histopathological findings on brain biopsy is MOST suggestive of melanoma?

[ A ] Pleomorphic cells, positive for GFAP (glial fibrillary acidic protein) on immunoperoxidase stains, arranged in a palisade-like pattern, with a high mitotic index, evidence of neovascularization and necrotic areas.
[ B ] Necrotic areas of tissue with occasional giant cells containing small rodlike organisms reactive with acid-fast stains.
[ C ] Amelanotic, pleomorphic large cells with a high mitotic index, neovascularization, and immunoperoxidase staining positive for keratin and S-100 protein.
[ D ] Amelanotic cells arranged in an acinar pattern, with positive mucin staining and a low to moderate mitotic index.

Test Yourself — Patient 43