Pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe

Abstract

Objective To investigate the clinical manifestations and pathological characteristics of pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe of brain.  Methods  The clinical manifestations, pathological features and differential diagnosis were studied in one case of pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe. Related literatures were also reviewed.  Results  A 56-year-old male suffered from intermittent headache for 3 years in fronto-occipital region without significant incentives. Cranial MRI examination revealed a space-occupying lesion in right frontal lobe, which was considered as meningioma. In operation, the tumor located in the right frontal lobe was tough and red-grey in color, with clear boundary and abundant blood supply. Histopathological examination revealed the tumor was arranged in papillary pattern. The tumor cells were large, with eosinophilic cytoplasm, round or oval nuclei and small red nucleoli. Especially, a plenty of psammoma bodies were found in tumor tissue and mesenchymal tissue. Immunohistochemical staining found that the tumor cells were positively expressed for cytokeratin (CK), epithelial membrane antigen (EMA), CK19, thyroid transcription factor-1 (TTF-1) and Napsin A, and showed focal positive expression of P53. Ki-67 labeling index was 5%-10%. The tumor cells were negative for glial fibrillary acidic protein (GFAP), S-100 protein (S-100), thyroglobulin (TG), Galectin-3 protein, progestrone receptor (PR) and vimentin (Vim). Combined with the results of chest ¹⁸F-FDG-PET CT, the final diagnosis was pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe. The patient underwent auxiliary radiotherapy and chemotherapy after operation. The patient was followed for 12 months and no recurrence was seen.  Conclusions  This case is very rare. Understanding the patient's history and differentiating from other primary intracalvarium tumors is one of the key steps to give the right pathological diagnosis and clinical therapy. In order to avoid disdiagnosis, the diagnosis needs to be differentiated from other primary intracalvarium tumors, including papillary meningioma, papillary tumor of choroid plexus, papillary ependymoma, papillary glioneuronal tumors as well as metastatic papillary thyroid carcinoma.

DOI: 10.3969/j.issn.1672-6731.2015.06.009