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Case Reports in Oncological Medicine
Volume 2012, Article ID 192807, 4 pages
http://dx.doi.org/10.1155/2012/192807
Case Report

Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma

1Department of Neurosurgery, University Hospital, 37126 Verona, Italy
2Operative Unit of Neurosurgery, Regional General Hospital, Via L. Boehler 5, 39100 Bolzano, Italy
3Internal Medicine, General Hospital, 39028 Silandro, Italy
4Service of Pathology, Regional General Hospital, 39100 Bolzano, Italy

Received 31 July 2012; Accepted 10 October 2012

Academic Editors: Y.-F. Jiao and B. I. Razzouk

Copyright © 2012 Antonio Biroli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Brain metastases arise in 10%–40% of all cancer patients. Up to one third of the patients do not have previous cancer history. We report a case of a 67-years-old male patient who presented with confusion, tremor, and apraxia. A brain MRI revealed an isolated right temporal lobe lesion. A thorax-abdomen-pelvis CT scan showed no primary lesion. The patient underwent a craniotomy with gross-total resection. Histopathology revealed an intestinal-type adenocarcinoma. A colonoscopy found no primary lesion, but a PET-CT scan showed elevated FDG uptake in the appendiceal nodule. A right hemicolectomy was performed, and the specimen showed a moderately differentiated mucinous appendiceal adenocarcinoma. Whole brain radiotherapy was administrated. A subsequent thorax-abdomen CT scan revealed multiple lung and hepatic metastasis. Seven months later, the patient died of disease progression. In cases of undiagnosed primary lesions, patients present in better general condition, but overall survival does not change. Eventual identification of the primary tumor does not affect survival. PET/CT might be a helpful tool in detecting lesions of the appendiceal region. To the best of our knowledge, such a case was never reported in the literature, and an appendiceal malignancy should be suspected in patients with brain metastasis from an undiagnosed primary tumor.