CYSTIC BRAIN METASTASIS AS PRESENTATION FOR SMALL CELL LUNG CANCER IN A 25 YEAR OLD FEMALE

Abstract

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extensive stage small cell lung cancer (SCLC) is associated with brain metastases in 40-50% of cases, usually presenting as solid lesions. Cystic brain metastases in SCLC, however, are extraordinarily rare. We present a case of a previously healthy, non-smoking female who was diagnosed with SCLC with widespread metastatic disease, including cystic brain metastasis. CASE PRESENTATION: A 25 year old female with history of asthma presented with a one month history of headaches, right sided weakness, and episodic twitching. The patient denied smoking and illicit drug use, but admitted to social alcohol intake. Travel history included a trip to Mexico several years prior, but she had no other international travel. After sustaining several unintentional falls at home, she sought neurology evaluation, where brain MRI was performed, which demonstrated multiple ring-enhancing cystic lesions. Lab work was notable for negative HIV testing and negative fungal serologies. Computed tomography of the chest, abdomen, and pelvis revealed an irregular 1.8 x 1.1 x 2.0 cm left upper lobe nodule with a 4.5 x 3.2 x 5.5 cm left hilar mass, numerous liver lesions, and right inguinal lymphadenopathy suspicious for malignancy. The patient underwent liver lesion biopsy which uncovered metastatic, high-grade neuroendocrine carcinoma, and a diagnosis of metastatic SCLC cancer was made. For symptomatic treatment, the patient underwent craniotomy with removal of a 3 x 3 x 1 cm left frontal mass, also consistent with metastatic SCLC. She was referred to oncology and received multiple cycles of systemic chemo-immunotherapy with carboplatin, etoposide, and Atezolizumab. Her most recent brain imaging demonstrates progression despite maintenance immunotherapy for 6 months after initial diagnosis. DISCUSSION: The differential diagnosis for cystic brain lesions includes malignancy, infectious causes, and inflammatory causes such as multiple sclerosis and sarcoidosis. Although cystic brain lesions from NSCLC are a known entity, cystic brain lesions secondary to SCLC are exceptionally rare with only three cases reported in the literature. Treatment of cystic brain metastasis is especially challenging, due to decreased responsiveness to radiotherapy. Treatments may include a combination of whole brain radiation, radiosurgery, neurosurgery, cyst aspiration, and chemotherapy. Combination of cyst aspiration plus radiosurgery is one possible method that may improve morbidity and mortality rather than radiosurgery alone, especially in cases of cysts larger than 10 mL in volume. Based upon experiences with other malignancies, cystic brain metastases confer worse prognosis. CONCLUSIONS: Cystic brain metastases are a rare complication in SCLC and likely associated with poorer outcomes. Currently, there are no general treatment guidelines for cystic brain metastasis. Reference #1: Quan AL, Videtic GM, Suh JH. Brain metastases in small cell lung cancer. Oncology (Williston Park). 2004;18(8):961-987. Reference #2: Kim M, Cheok S, Chung LK, et al. Characteristics and treatments of large cystic brain metastasis: radiosurgery and stereotactic aspiration. Brain Tumor Research and Treatment. 2015 Apr;3(1):1-7. DOI: 10.14791/btrt.2015.3.1.1. Reference #3: Sun B, Huang Z, Wu S, et al. Cystic brain metastasis is associated with poor prognosis in patients with advanced breast cancer. Oncotarget. 2016;7(45):74006-74014. doi:10.18632/oncotarget.12176 DISCLOSURES: No relevant relationships by Sunjay Devarajan, source=Web Response No relevant relationships by Todd Schlossman, source=Web Response