CASE REPORT

Brain Abscess as Initial Presentation of Metastatic Adenocarcinoma and Melanoma

  • Raiza Marques Vieira Campos (1)    Raiza Marques Vieira Campos (1)
  • Laura Reyes González (2)    Laura Reyes González (2)
  • José Luís Simões Júnior (1)
  • William Manoel da Silva (1)
  • Ana Beatriz da Silva Alvares (3)    Ana Beatriz da Silva Alvares (3)
  • Emanuele Pires Canela dos Santos (3)    Emanuele Pires Canela dos Santos (3)
  • Maicon Santos Gonçalves (3)    Maicon Santos Gonçalves (3)
  • Osmi Hamamoto (4)    Osmi Hamamoto (4)
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Resumo

Introdução: Relatos de casos da coexistência de abscessos cerebrais e processos neoplásicos são escassos, sendo sua fisiopatologia ainda incerta. Neste artigo, relatamos dois casos de tumores cerebrais metastáticos mimetizando abscessos cerebrais. Relatos de Casos: Mulher de 65 anos com déficit neurológico e ressonância magnética cerebral mostrando lesão anular frontal esquerda de 3,3x3x4cm e halo de extenso edema frontotemporoparietal ipsilateral, sugestivo de abcesso cerebral. Foi submetida a trepano punção com aspiração de 20ml de secreção purulenta e, devido à persistência dos sintomas, foi submetida à ressecção cirúrgica da lesão frontal com análise anatomopatológica e imuno-histoquímica evidenciando adenocarcinoma pulmonar metastático, perfil de expressão de queratina (CK7+/CK20-) e co-expressão de TTF-1 e Napsina. No segundo caso, homem de 58 anos com déficit neurológico súbito e ressonância magnética cerebral mostrando lesão talâmica direita de 1,9x1,5cm sugestiva de abscesso cerebral. Por falha na resposta à antibioticoterapia empírica e evolução com perda sensitiva, foi realizada biópsia da lesão talâmica e derivação ventricular externa. As análises anatomopatológicas e imuno-histoquímicas relataram melanoma metastático com anticorpos HMB45, S-100 e Melan-A positivos. Conclusão: Este é o relato do segundo caso confirmado de abscesso simulando tumor cerebral na região supratentorial e o primeiro caso descrevendo um melanoma metastático com diagnóstico inicial de abscesso cerebral.

Palavras-chave

Metástase cerebral; Abscesso cerebral; Melanoma; Adenocarcinoma pulmonar

Abstract

Introduction: Case reports of the coexistence of brain abscesses and neoplastic processes are scarce, being its pathophysiology still unclear. In this paper, we report two cases of metastatic brain tumors mimicking brain abscesses. Cases presentation: A 65-year-old woman with neurological deficit and a brain MRI showing a 3.3x3x4cm left frontal annular lesion and a halo of extensive ipsilateral frontotemporoparietal edema, suggestive of brain abscess. She was submitted to trepanopuncture with aspiration of 20ml of purulent secretion and, due to persistence of the symptoms, she underwent surgical resection of the frontal lesion with anatomopathological and immunohistochemistry analyses showing a metastatic lung adenocarcinoma, keratin expression profile (CK7+/CK20-) and co-expression of TTF-1 and Napsin. In the second case, a 58-year-old man with sudden neurological deficit and brain MRI showing a 1.9x1.5cm right thalamic lesion suggestive of a brain abscess. Due to failed response to empirical antibiotic therapy and evolution with sensory loss, a thalamic lesion biopsy and external ventricular shunt were performed. Anatomopathological and immunohistochemistry analyses reported metastatic melanoma with positive HMB45, S-100 and Melan-A antibodies. Conclusion: This is a report of the second confirmed case of an abscess mimicking a brain tumor in the supratentorial region and the first case describing a metastatic melanoma with initial diagnosis of a brain abscess.

Keywords

Brain metastasis; Brain abscess; Melanoma; Lung adenocarcinoma

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1MD, Neurosurgeon, Department of Neurosurgery, Hospital das Clínicas de Marília, Marília, São Paulo, Brazil.

2MD, MR, Medical Residency in Neurosurgery, Department of Neurosurgery, UNICAMP, Campinas, São Paulo, Brazil.

3MD, MR, Medical Residency in Neurosurgery, Department of Neurosurgery, Hospital das Clínicas de Marilia, Marília, São Paulo, Brazil.

4MD, PhD, Neurosurgeon Chief, Department of Neurosurgery, Hospital das Clínicas de Marília, Marilia, São Paulo, Brazil.

 

Received Dec 18, 2022

Corrected July 19, 2023

Accepted July 22, 2023

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JBNC  Brazilian Journal of Neurosurgery

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