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\begin{document}

\title{Metastasis of Pulmonary Adenocarcinoma presenting as Multiple Cystic
Lesions of the Brain: Importance of Differential Diagnosis}



\author[1]{Dragan Janković}%
\author[1]{Harald  Krenzlin}%
\author[1]{Naureen Keric}%
\author[1]{Florian  Ringel}%
\affil[1]{University Medical Centre of the Johannes Gutenberg University Mainz}%


\vspace{-1em}



  
  \date{June 13, 2024}


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\selectlanguage{english}
\begin{abstract}
A 62-year-old otherwise healthy patient was admitted with severe
headache for several weeks. Initial imaging studies revealed multiple
cystic lesions in both hemispheres. Neuroparasitic infections were
considered as primary differential diagnosis. Open biopsy of a right
frontal cortical lesion was performed. Pathohistological revealed the
diagnosis of cerebral metastasis of adenokarcinoma.%
\end{abstract}%



\sloppy


Metastasis of Pulmonary Adenocarcinoma presenting as Multiple Cystic
Lesions of the Brain: Importance of Differential Diagnosis

Dragan Jankovic\textsuperscript{1}, Harald Krenzlin\textsuperscript{1},
Naureen Keric\textsuperscript{1}, Florian Ringel\textsuperscript{1}

\textsuperscript{1}Department of Neurosurgery, University Medical Centre
of the Johannes Gutenberg University of Mainz, Mainz, Germany

\emph{Corresponding author:}

Dragan Jankovic, MD

Department of Neurosurgery

University Medical Center Mainz

Johannes Gutenberg University of Mainz

Langenbeckstr. 1

55131 Mainz, Germany

Phone: +49-6131-177331

Fax: +49-6131-172274

Email: dragan.jankovic@unimedizin-mainz.de

\textbf{Abstract} A 62-year-old otherwise healthy patient was admitted
with severe headache for several weeks. Initial imaging studies revealed
multiple cystic lesions in both hemispheres. Neuroparasitic infections
were considered as primary differential diagnosis. Open biopsy of a
right frontal cortical lesion was performed. Pathohistological revealed
the diagnosis of cerebral metastasis of adenocarcinoma.

\textbf{Accompanying text}

Cystic lesion of brain can present in several diseases, such as
inflammatory and demyelinating disorders, bacterial and fungal
infections, parasitic disease, but also as metastases and primary brain
tumor.\textsuperscript{1}

We present a case of a 62-year-old otherwise healthy male presented with
severe headache for a several weeks. Neurologic examination revealed a
mild dysdiadochokinesia. Magnetic resonance imaging (MRI) demonstrated
supra- and infratentorial disseminated cystic lesions, which lead to
generalized cerebral edema. Radiographic appearance was suggestive of
neuroparasitic disease, such as Toxoplasmosa, Neurocysticercosis,
Echinococcosis.

Routine blood test showed elevated white blood cell counts and normal
C-reactive Protein (CRP) values. Blood cultures and screening tests for
Toxoplasmosis, Neurocysticercosis, Echinococcosis and Toxocara returned
negative. Immunserological findings revealed a relevant increased ANA
titer.

As a definitive diagnosis remained elusive, open neuronavigated brain
biopsy of right frontal lesion was performed. Histopathological analysis
revealed a brain metastasis of an adenocarcinoma. Chest CT revealed a
2,7 x 1,9 x 2,3 cm large tumor in the right lower lobe bronchus.

After the diagnosis was confirmed, the patient underwent whole brain
radiotherapy (WBRT), followed by chemotherapy. A follow-up MRI of brain
showed clearly decreasing Metastases supra- and infratentorial with
decreasing perifocal edema. The patient has no new neurological
deficits.

CONFLICT OF INTEREST

Authors have no conflict of interest to disclose.

Conflict of interest: Authors have no conflict of interest do disclose.

Author contributions: DJ: wrote the manuscript. HK and NK: editing and
proofread the manuscript. FR: supervision.

\textbf{References}

1. Marta GN, da Cunha Colombo Bonadio RR, Martins RE, Zuppani HB, de
Castro G Junior. Cystic brain metastases in ALK-rearranged non-small
cell lung cancer. Ecancermedicalscience. 2018;12:818.

\textbf{Figure legends}

Figure 1. T1 magnetic resonance imaging sequences showing a
supratentorial and infratentorial multiple lesions with perifocal edema;
(a) axial, (b) axial, (c) coronal, (d) sagittal\selectlanguage{english}
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