# Brain and Meningeal Metastases of Lung Cancer Manifested as Brain Calcifications: A Case Report and Literature Review

## TL;DR

A lung cancer patient showed brain calcifications due to metastases, highlighting the risk of misdiagnosis and the importance of considering cancer recurrence in patients with a history of cancer.

## Contribution

This case emphasizes the under-recognized association between brain calcifications and metastatic lung cancer.

## Key findings

- Brain calcifications can be a manifestation of undiagnosed lung cancer brain and meningeal metastases.
- EGFR L858R mutation was identified, and targeted therapy with osimertinib improved the patient's symptoms.
- Literature review shows brain calcifications are often misattributed, leading to delayed cancer treatment.

## Abstract

肺癌目前仍是全球最常见的恶性肿瘤之一，随着其发病率的升高及医疗技术的发展，肺癌患者的总生存期较前明显延长。肺癌脑及脑膜转移发生率也逐年升高，但预后较差，病死率极高，诊断主要通过计算机断层扫描（computed tomography, CT）及磁共振成像（magnetic resonance imaging, MRI）等影像学检查，但影像特征多样，特异性较低，极易误诊及漏诊。因此，准确识别脑及脑膜转移并及时进行针对性治疗，对于改善肺癌患者的预后至关重要。本文通过对1例肺癌根治术后近7年长期随访无明显复发转移但近5个月患者出现行为异常、意识障碍及癫痫等症状，头颅CT及MRI发现脑部多发点状钙化灶病例的诊疗经过进行分析，在排除感染及自身免疫性脑炎相关治疗无效后，考虑患者精神行为症状是肺癌脑及脑膜转移所致，进一步病理活检及基因检测，明确诊断为转移性肺腺癌且表皮生长因子受体（epidermal growth factor receptor, EGFR）L858R基因突变，使用奥希替尼靶向治疗后患者症状明显改善；同时，检索中国知网、万方、UpToDate、PubMed等数据库关于脑部钙化灶的相关文献并进行分析，发现脑内钙化存在于多种疾病中，包括感染性、遗传性和神经退行性疾病、血管相关综合征、代谢性疾病和肿瘤，但钙化相关的脑（膜）转移灶往往是被低估的，随之而来的风险是误诊和延迟治疗。因此，对于既往罹患肿瘤病史的患者，以钙化为主要表现的脑（膜）转移灶不容忽视。

Brain tissue genetic testing report (gene variants with definite clinical significance)