Multiple Cystic Brain Metastases from Lung Adenocarcinoma: A Case Report and Literature Review

Abstract

Introduction: Multiple cystic brain metastases are a rare form of tumor dissemination, typically occurring in lung adenocarcinomas. Their management is complex and non-standardized, with cyst drainage playing an essential role in reducing intracranial pressure and controlling neurological symptoms. Case Report: We report the case of a 64-year-old female patient with no known history of neoplasia, who presented with progressive neurological symptoms (headaches, dizziness, memory disturbances) associated with chronic dry cough. Brain imaging revealed multiple intraparenchymal cystic lesions, bilateral, supratentorial and infratentorial, with slight peripheral enhancement. Staging workup revealed a tumor in the left upper lobe, mediastinal lymphadenopathy, and a suspicious adrenal nodule. CT-guided lung biopsy confirmed a moderately differentiated adenocarcinoma. The patient underwent whole-brain radiotherapy and chemotherapy, in the absence of driver mutations. The clinical course was marked by progressive neurological deterioration, and the patient died 8 months after diagnosis. Conclusion: This case illustrates the severity of multiple cystic brain metastases, whose prognosis is more reserved than that of solid metastases. In the presence of neurological signs in a cancer patient, this diagnosis should be considered. Management relies on a multidisciplinary approach combining surgical drainage, radiotherapy, and targeted therapies when possible.