CHSU Discovery

Primary brain tumors are considered relatively rare. Most cases of brain tumors consist of metastatic disease from the lung, breast, colon, and kidney. The most common primary brain tumors include meningiomas, glioblastomas, and astrocytomas. Brain tumor presentations depend on location, but the most common symptoms include headaches, seizures, nausea, and vomiting. Papilledema, headaches, and vomiting are usual signs of elevated intracranial pressure.  We present a rare case of a possible primary brain tumor of unknown cell origin with some neuroendocrine markers. This case offers the diagnosis, presentation, and management of a patient with a brain tumor that has not been reported in past literature. In this case, we include this patient's initial workup, imaging, management, and follow-up of a poorly differentiated frontal brain neoplasm. A 64-year-old female with end-stage renal disease presented to the ED for a 5150, refusing dialysis treatment and acting as a threat to herself. Workup included CT head indicated right frontal mass with edema and left frontal lesion with calcifications. The patient was taken for a right-sided stereotactic biopsy. Biopsy results showed CD 45 - and CD 56 + cells staining significantly for possible neuroendocrine tumors. Final pathology indicated a poorly differentiated malignant neoplasm. Post-op, the patient was taken for a whole body PET scan, which was negative for any primary sites of tumor. The patient is currently being managed by radiation oncology. This report presents a unique presentation of a brain tumor. Work was done to find a cause and the initial management specific to the case.