Case of single solitary fibrous tumour brain metastasis in patient with adenocarcinoma of the lung.
This case highlights a single solitary fibrous tumour brain metastasis in a patient with simultaneous adenocarcinoma of the lung. A 70-year-old navy veteran who served in Vietnam for 14 months presented with progressive shortness of breath. While he was serving in Vietnam, he reported being exposed to Agent Orange. His medical history revealed congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease from tobacco and a previous coronary artery bypass.
Diagnosis and treatment
Examination showed progressive shortness of breath. Doctors advised further investigations including a CT of the chest without contrast. The CT revealed two distinct appearing tumours in the right upper lobe and lower lung measuring 1.5 cm and 13 cm. The right upper lobe tumour was consistent with a moderately differentiated adenocarcinoma. Histopathology showed focal invasion of the visceral pleura which was confirmed by elastic stain. The right lower lobe tumour was consistent with single solitary fibrous tumour. The patient was negative for metastatic disease from either tumour. The surgical margins were negative for tumour in both cases. There was no additional therapy recommended at the time and the patient was asked to follow up for clinical visits and imaging studies.
The patient did well for the next 15 months. However, there were multiple new pulmonary tumours seen on the restaging CT with contrast. The patient also presented with mild weakness in his right leg shortly after the CT scan was performed. MRI of the brain showed a solitary enhancing mass of the left posterior frontal lobe, measuring 2.5 cm. The findings were consistent with a metastatic brain lesion.
Treatment plan included a left frontal craniotomy with gross total tumour resection. The right upper lobe lung metastasis was found to be metastatic adenocarcinoma. The patient was prescribed systemic treatment with pembrolizumab, carboplatin, and Alimta and tolerated systemic therapy. However, he still continues to have chronic dry cough, generalised dyspnea on exertion and generalised weakness. In addition, he did not develop any recurrence of brain metastasis even 16 months since the Gamma Knife treatment. He is currently on treatment with pembrolizumab.
References
Single Solitary Fibrous Tumor Brain Metastasis in a Patient with Simultaneous Adenocarcinoma of the Lung: Case Report and Review of the Literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166291/
