Bilateral Symmetric Thalamic Metastasis in a Patient with Small Cell Lung Cancer

Abstract

A 68-year old woman was referred to our hospital because of
dry cough with persistent numbness in the extremities. Chest
roentgenogram showed right hilar tumor with mediastinal lymphnode
and brain magnetic resonance imaging (MRI) revealed
multiple tiny nodules. After performing the transbronchial needle
aspiration obtained from subcarinal lymphnode, she was diagnosed
with small cell lung cancer (SCLC) accompanied by multiple
brain metastasis (clinical stage IV: T4N3M1). After completion of
four cycles of chemotherapy, the size of lung lesion was regressed
together with complete resolution of brain lesions, and she discharged
uneventfully. However, her numbness was remained. Four
months later, she was hospitalized again for severe numbness in her
trunk and extremities. Brain MRI (contrast-enhanced T1-weighted
image) demonstrated new symmetric metastatic lesions in bilateral
thalamus (Figure A and B) as well as left putamen. Another two
months later, numbness exacerbated and spread from the top to
toe with the growing of primary and bilateral thalamic metastatic
lesions on computed tomography (CT) (Figure C and D). In spite
of whole-brain irradiation, she had suffered from severe numbness,
and died of obstructive pneumonia. To our knowledge, this
is the first case of bilateral symmetric thalamic metastasis in SCLC
with refractory numbness over the whole body.