Brain metastases from renal cell carcinoma

Discussion:

Cerebral metastasis is common and is suspected in patients with primary malignancies with neurological manifestations. Renal cell carcinoma is one of the commonest primaries of brain metastasis.

Cerebral metastases are usually solid, however, it can show cystic changes as tumor-associated cysts or due to necrosis, also it can be predominately cystic with a marginal enhancing solid component as in this case. Brain metastasis can show hemorrhagic changes, especially at their cystic component. Other common primaries for brain metastasis include lung cancer, breast cancer, colorectal carcinoma and melanoma.

About half of brain metastasis are solitary, and history of primary malignancy aids in suggesting metastasis rather than the primary tumor, especially if associated with other sites of metastasis as solitary metastasis can entirely appear in MRI like a primary intra-cranial tumor and it needs different management.

MRI is more sensitive than CT in detecting brain metastasis, especially in contrast-enhanced T1 WI.

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