Purpose

Adenocarcinoma of lung, a subtype of non small cell lung cancer frequently metastasizes to the brain and may rarely mimic infectious etiologies radiologically
This overlap may lead to diagnostic delay, especially in absence of systemic symptoms suggestive of malignancy

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Methods

A 61-year-old male presented with a 5-month history of headache and diplopia. Ocular examination showed a best-corrected visual acuity (BCVA) of 20/40 in both eyes, defective color vision in the right eye, significant ptosis and limited extraocular movements in both eyes. Fundus examination revealed two hypopigmented choroidal lesions in the left eye.
Ocular B-scan ultrasound indicated large hypoechoic cystic lesions in the extraocular muscles. Contrast-enhanced MRI of the brain revealed multiple nodular and ring-enhancing lesions, suggestive of a scolex, and nodular enhancing lesions in the recti and oblique muscles, causing optic nerve compression and an intraocular lesion in the left eye, consistent with disseminated neurocysticercosis and ocular myocysticercosis.
MRI of the abdomen and thorax found multiple nodular lesions in the liver, chest wall, paraspinal muscles, and a nodule in the right lung.
Cytosmears from the BAL fluid showed malignant epithelial cells arranged in clusters.
Microscopy of the biopsy showed irregular atypical gland formation with thickened alveolar septa.The glands are having enlarged, hyperchromatic nuclei, prominent nucleoli,increased N/C ratio and desmoplastic stroma .
Immunohistochemistry stained positive for TTF-1 and negative for P40.

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Results

The diagnosis on HPE was Non small cell carcinoma lungs, possibly Adenocarcinoma.The patient was placed on palliative care and passed away about one month later.

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Conclusion

This case underscores the need for a differential diagnostic approach for atypical radiological findings that may mimic neurocysticercosis, as early misdiagnosis delayed identifying the patient’s primary cancer. Even in the absence of systemic symptoms, malignancy should be considered in cystic brain lesions..

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Additional Authors

First name	Last name	Base Hospital / Institution
Kaushik	Sadhukhan	All India institute of Medical Sciences, Kalyani
Subodh	Lakra	All India institute of Medical Sciences, Kalyani

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