Advanced neuroimaging studies in a patient with brain metastases from transitional cell carcinoma of the bladder

J Neuroimaging. 2014 Jul-Aug;24(4):429-31. doi: 10.1111/jon.12024. Epub 2013 Apr 2.

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.

Keywords: Bladder cancer; magnetic resonance spectroscopy; neoplasm metastasis; nuclear radiology; receptors; somatostatin.

Publication types

  • Case Reports

MeSH terms

  • Aspartic Acid / analogs & derivatives*
  • Aspartic Acid / analysis
  • Biomarkers, Tumor / analysis*
  • 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 / methods
  • Male
  • Middle Aged
  • Urinary Bladder Neoplasms / chemistry
  • Urinary Bladder Neoplasms / diagnosis*

Substances

  • Biomarkers, Tumor
  • Aspartic Acid
  • N-acetylaspartate