PMC8776831_01
Comparisons of cranial MRI results before (A) and after (B) admission. Both (A,B) reveal multiple nodular abnormal signals in bilateral cerebral and cerebellar hemispheres, mainly in the cortical and cortical medullary junctions, with lesions series (B) significantly larger than that in series (A). T2WI and T2flair are mainly low signals, with high signals in some lesions. T1flair shows equal and low signals, with obvious edema around the lesions.
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F1
PPD test. Plain and enhanced head MRI revealed bilateral multiple intracranial lesions suggesting tuberculosis or possible metastatic tumors (Figure 1A). When he returned for follow-up 1 month later, his head MRI showed bilateral lesions wider than those of the previous one (Figure 1B).
Comparisons of chest CT results before (A) and after (B) admission. (A) shows the patchy shadow in the left lower lobe, with mediastinal lymphadenopathy. (B) shows that the left lower lung lesions are enlarged than before, with a solid shadow and lymphadenopathy.
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F2
An enhanced CT scan of the chest showed bilateral pulmonary patchy infiltrates, most prominent in the left lower lobe dorsal segment, and an enlarged mediastinal lymph node (about 2.5 x 1.6 cm) without pleural effusion (Figure 2A). Chest CT indicated bilateral scattered lesions, with the lesion in the left lower lobe and the mediastinal lymph node larger than before and associated with high density lesions in the lower left oblique fissure (Figure 2B).
Anatomical examination of lung and brain. (A): Gray-white hard nodules were seen in the hilar and lower lobe. There was a hard mass in the mediastinum, about 5 cm x 2 cm in size. A small amount of gelatinous material was seen in the right main bronchus and pulmonary congestion was seen on section. (B): Multiple hard nodules with bleeding were seen on both sides of the cerebral hemisphere and cerebellum.
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F3
With the consent of the patient's family, an autopsy was performed, and it revealed multiple nodular lesions in the lungs and brain (Figure 3), no tumor in other organs.
Pathological results of lung and brain tissues. (A): The tumor cells in the pulmonary nodules are arranged in a single thin-walled vascular lumen, filled with red blood cells and accompanied by necrosis, and have a large nuclear-cytoplasmic ratio, dark-colored nuclei and atypia. (B): The lesions of the brain tissue are similar to those of the pulmonary nodules, accompanied by hemorrhage and necrosis. The surrounding brain tissue can be seen in the cuff-like infiltration of lymphocytes-based inflammatory cells around the blood vessels. Necrophages and satellite cells can also be observed. (C,D) respectively represent immunoreactivity for CD31 and CD34 on immunohistochemical examination (Magnifications: (A), x100; (B,C), x200; (D), x400).
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F4
Histopathology of the lesions confirmed the diagnosis of PPA with brain metastasis (Figure 4).