Advanced Neuroimaging Studies in a Patient with Brain Metastases from Transitional Cell Carcinoma of the Bladder

• Published in: Journal of neuroimaging 2014-07, Vol.24 (4), p.429-431
• Main Authors: Choi, Yoon J., Gabikian, Patrik, Zhu, Fang, Appelbaum, Daniel E., Wollmann, Robert, Lukas, Rimas V.
• Format: Article
• Language: English
• Subjects: Aspartic Acid - analogs & derivatives; Aspartic Acid - analysis; Biomarkers, Tumor - analysis; Bladder; Bladder cancer; Brain Neoplasms - chemistry; Brain Neoplasms - diagnosis; Brain Neoplasms - secondary; Carcinoma, Transitional Cell - chemistry; Carcinoma, Transitional Cell - diagnosis; Carcinoma, Transitional Cell - secondary; Humans; Magnetic Resonance Imaging - methods; magnetic resonance spectroscopy; Magnetic Resonance Spectroscopy - methods; Male; Medical treatment; Metastasis; Middle Aged; neoplasm metastasis; Neuroimaging; NMR; Nuclear magnetic resonance; nuclear radiology; receptors; somatostatin; Urinary Bladder Neoplasms - chemistry; Urinary Bladder Neoplasms - diagnosis
• ISSN: 1051-2284; 1552-6569
• DOI: 10.1111/jon.12024

ABSTRACT BACKGROUND AND PURPOSE The differential diagnosis in single or oligo‐brain lesions in metastatic cancer patients remains broad. Advanced imaging studies can be employed to help refine the differential and potentially guide treatment. METHODS Case report of a 52‐year‐old male patient with known transitional cell carcinoma of the bladder presented with headaches, cognitive symptoms, and episodic presyncope. Brain magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and octreotide scans were performed to evaluate the underlying etiology of his symptoms. RESULTS MRI revealed two enhancing mass lesions in left temporal and left cerebellar locations. Both lesions were octreotide avid and MRS of the temporal lesion showed a single large lipid peak at 1.3 ppm, a small NAA peak, and a markedly increased choline:creatine ratio that was relatively characteristic for metastases. Pathology from surgical resection revealed transitional cell carcinoma of the bladder. CONCLUSIONS Resection of both lesions revealed metastatic transitional cell carcinoma. This is the first report of octreotide scan characteristics in a patient with transitional cell carcinoma with central nervous system (CNS) metastases. The octreotide avidity of these transitional cell CNS metastases suggests the presence of somatostatin receptors that may be considered as a potential therapeutic target.