PMC9508522_01
Brain magnetic resonance imaging: A. Irregular leptomeningeal thickening at the right Rolando fissure (thickness 2 mm), as well as smaller adjacent focal parietal leptomeningeal thickening (FLAIR sequence); B. Supratentorial hydrocephalus of recent onset associated with interstitial/transependymal edema (FLAIR sequence); C. No expansive lesions or enhancements in the brain parenchyma (T1 with contrast).
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Total body 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET-CT): A. Pulmonary hypermetabolism without neoplastic mass in tomographic scanning (lung); B. FDG hypermetabolism at the right parietal region (cerebral).
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These findings were suggestive of pulmonary neoplasia with leptomeningeal metastases ( Figure 2).
Pathology slides with immunohistochemistry and markers used in unknown primary adenocarcinoma and corresponding to lung adenocarcinoma: A. Atypical cells in the leptomeningeal region with positive staining for CK7; B. Atypical cells in the leptomeningeal region with negative staining for CK20.
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The patient underwent a new intervention with an open brain biopsy, obtaining samples from the right leptomeningeal region, confirming the diagnosis of poorly differentiated primary non-small cell lung adenocarcinoma ( Figure 3).