Just the Two of Us

The persistent coughing prompted re-evaluation of the pre-operative chest X ray, which disclosed non-specific nodules. A chest CT-scan showed multiple pulmonary nodules and confluent mediastinal lymphadenopathies consistent with a metastatic process. A whole body PET scan confirmed hypermetabolic enlarged bilateral hilar and mediastinal lymphadenopathy and FDG-avid right supraclavicular lymph nodes. Bronchoscopy with broncho-alveolar lavage was performed, completed by trans bronchial needle aspiration, revealing a tumour with cribriform and papillary architecture, positive for TTF1 and CK7, confirming the diagnosis of lung adenocarcinoma. The initial meningioma diagnosis was challenged and reviewed, confirming presence of meningothelial cells, but also showing evidence of additional intrameningeal metastatic adenocarcinoma, suggesting a final diagnosis or tumour-to-tumour metastasis. The papillary/glandular portion of the meningeal tumor was indeed identical (positive CK7, TTF-1 and Napsin) with the sample analyzed in the lung biopsy. The patient declined chemotherapy, but underwent adjuvant brain radiotherapy (60Gy, 30 fractions). Five months post-operatively, the patient recovered 6/12 vision in the previously blind eye and visual fields improved significantly. Sequential follow-up brain MRIs over 6 months showed no recurrence of the tumor.