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MR Spectroscopy Case Study
Metestaitc Large Cell Carcinoma
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Prepared by Greg Brown    Royal Adelaide Hospital North Terrace Adelaide South Australia 5000
February 28th 2001		 Back to MRS Page

Images and Spectra obtained on a Siemens VISION 1.5T using Numairs VB33E software.  Images and Spectra converted to JPEG files using eFilm.

Presentation Imaging MRS Technique MRS Results Histopathology Discussion

Presentation
DH. Four month history of  severe headaches, now presents with raised intra-cranial pressure nausea, vomitting, pin prick pupils,.  ?sub dural or subarachnoid haemorrhage.

Imaging
 
CT An enhancing isodense mass in posterior fossa with moderate oedema.
CT Chest identified a likely carcinoam of the lung
MRI Solitary mass lesion in the cerebellar vermis. Presumed metastasis

MRS Technique
SVS SE135 within the mass lesion

MRS Results
 
No comparison to normal tissue, but a very high Choline peak.  Peaks at 1.7 and 1.4 are braod and probsabl;y represent lipids.  Integral values and ratios were not collected.  The high choine indicates tumour, lipids may represent level of tumour malignancy. We have observed them in the late echo spectra, only in cases of carcinoma and adenoma metastases to date, and not in primary  brain lesions.


Histopathology
Brain biopsy 15 days after MRS.  Metestatic undifferentiated large cell cacrinoma with features of squamoid differentiation.  There is extensive tumour necrosis with focal areas of clear cell change. Pleomorphic cells are arranged in sheets and clumps displaying pleomorphic nuclei and frequent mitoses.


Discussion
The MRI identified a solitary lesion of uncertain nature.   The MRS only confirmed  that it was a tumour, but it did that accurately.