Case Report

Brain Metastasis From Thymic Carcinoma in Association with SIADH and Pituitary Enlargement: A Case Report

Authors: Mohammad Sami Walid, MD, PhD, Earl Christopher Troup, MD, FACS, Joe Sam Robinson Jr., MD, FACS

Abstract

A 49-year-old white female presented to the emergency room complaining of severe headaches. A brain computed tomography (CT) showed a large right temporal mass that measured 2.9 × 5 cm. Sodium was low at admission, which indicated syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Her pituitary gland was enlarged. Thorax CT revealed a large anterior mediastinal mass measuring 6.3 × 3.6 cm. Pathology revealed a poorly differentiated carcinoma arising from the thymus. This case is unique because thymic cancer rarely results in brain metastases and very rarely causes SIADH with changes in pituitary volume and signal quality.


Key Points


* Thymic carcinoma is a rare, indolent and invasive cancer that may produce metastases. Most patients present in the late stages of disease.


* A worsening pattern of migraine with nausea and vomiting should be thoroughly investigated, as these symptoms may be secondary to a brain tumor.


* Hyponatremia in a cancer patient may be a sign of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Attention should be paid to the pituitary silhouette for any change in size or signal pattern.

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