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Myeloid sarcoma (MS) is a tumor mass formed by the proliferation of one or more myeloid primitive cells outside the marrow, which is mostly related to acute myeloid leukemia (AML). It is reported that 2.5% to 9.1% of AML patients have MS, and AML with spinal canal MS is very rare. Spinal canal MS often has an acute onset and is difficult to diagnose. It is easy to cause missed diagnosis and misdiagnosis, which will lead to a delay in accurate diagnosis seriously affecting the treatment and quality of life among these patients. The clinical data, diagnosis and treatment process of a case of MS with multiple space occupying lesions in the spinal canal diagnosed and treated by the Department of Hematology of Peking Union Medical College Hospital are reported, in order to provide reference for clinical workers.
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Objective To investigate the effect of CT total tumor perfusion parameters in the identification of benign and malignant lung lesions. Methods 80 patients with pulmonary space-occupying lesions who were treated in our hospital from December 2015 to May 2017 were enrolled. After pathological histological diagnosis, 52 cases of malignant lesions and 28 cases of benign lesions were confirmed. And they all underwent CT whole tumor perfusion scan and perfusion imaging analysis. And the blood flow, blood volume, average transit time and surface permeability were obtained.Some cases of histopathological specimens were treated by monoclonal CD34 staining method, and the microvascularrich areas in the specimens were selected for blood vessel counting. The morphology of blood vessels was observed and microvessel density was obtained. Results The levels of BF, BV, MTT and PS in benign lesions were significantly lower than those in patients with malignant lesions. The best diagnostic threshold, sensitivity and specificity of BF in lung occupying lesions was> 49.12 mL/100 mL, 80.00% and 52.40%. The best diagnostic threshold, sensitivity and specificity of BV was 6.68 m L/100 mL, 70.00% and 81.00%. The best diagnostic threshold, sensitivity and specificity of MTT was3.82 m L/100 mL, 97.50 % and 52.40%. The best diagnostic threshold, sensitivity and specificity of PS was 7.25 mL/100 mL, 92.50% and 90.50%. The malignant lesion microvessel density count in the malignant lesions was significantly higher than that of benign lesions, and the difference was statistically significant (P<0.05). Conclusion CT total tumor perfusion parameters have a great auxiliary effect on the diagnosis of benign and malignant lung occupying lesions. Among them, PS and BV have the strongest sensitivity and are worthy of clinical promotion.
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Objective: To explore the clinical value of transthoracic echocardiography in diagnosis of atrial space occupying lesions. Methods: Data of 79 patients with atrial space occupying lesions diagnosed by echocardiography were reviewed. The echocardiographic characteristics were retrospectively analyzed and compared with surgical and pathological results. Results: Among 79 patients, there were 47 cases (47/79, 59.49%) with left atrial thrombi, 23 cases (23/79, 29.11%) with left atrial myxomas, 3 cases (3/79, 3.80%) with right atrial myxomas, 4 cases (4/79, 5.06%) with intracardiac leiomyomatosis and 2 cases (2/79, 2.53%) with malignant tumors transfered to the right atrium from adenocarcinoma of the lung. Echocardiographic diagnosis was consistent with surgical pathology results in 72 cases, whereas there were 2 cases of underdiagnosis, 2 cases of misdiagnosis and 3 cases of missed diagnosis. Conclusion: Echocardiography is the preferred image method for diagnosis of atrial space occupying lesions, which can provide important references for clinic treatment.
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Objective To investigate the value of intraoperative X-ray guided and CT guided percutaneous biopsy in the diagnosis of thoracic and lumbar space occupying lesions.Methods A total of 97 patients with thoracic and lumbar space occupying lesions who were not diagnosed clinically in our hospital from May 2011 to July 2016 were retrospectively analyzed.All patients underwent percutaneous vertebral biopsy under the guidance of Artis-Zeego robot in the Artis-Zeego complex operating room of our hospital.Thoracic vertebral body biopsy in patients with a total of 46 cases were divided into T group,in which X-ray guided percutaneous biopsy in 25 cases were divided into T-x group,CT guided percutaneous biopsy in 21 cases were divided into T-ct group.Lumbar puncture biopsy in patients with a total of 51 cases were divided into L group,in which X-ray guided percutaneous live review of 24 cases were divided into L-x group,CT guided percutaneous biopsy in 27 cases were divided into L-ct group.According to the packet respectively in X-ray or CT monitoring,the use of bone biopsy needle under local anesthesia,transpedicular approach for spinal lesions of bone amount,by changing the working path or direction bone biopsy needle of different diameter to save drilling samples which were immediately placed in 10% formalin,specimens were sent for pathological examination and corresponding pathological and cytological examination.The success rate,diagnostic accuracy and complications of percutaneous biopsy were compared between the two groups in X-ray and CT guided percutaneous vertebral biopsy.Results T-x group of 25 patients,5 patients with puncture failure for intraoperative X-ray monitoring difficulties were transferred to puncture under the guidance of CT,the success rate of puncture was 80% (20/25).Of the patients with success puncture,6 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy in T-x group was 70% (14/20).The success rate of puncture in T-ct group was 100%,significantly higher than that of T-x group(P < 0.05).In T-ct group,3 cases were unidentified by pathological examination,the total diagnostic accuracy rate of biopsy was 88.5 % (23/26),which was significantly higher than that of T-x group (P < 0.05).In the L-x group,1 case with puncture failure for pain during the operation,the success rate of puncture was 95.8% (23/24),patients of L-ct group were successfully punctured,the success rate was 100%,the difference between the two groups was not significant(P > 0.05).In the L-x group,2 patients failed to confirm the diagnosis,the diagnostic total accuracy rate of L-x group was 87.5% (21/23);of the L-ct group,1 cases failed to confirm the diagnosis,the diagnosis total accuracy rate of L-ct group was 96.3% (26/27),the difference between two groups was not significant (P > 0.05).Complications:In the T-x group,1 cases received additional local anesthetic after puncture for pain;1 patients had transient lower extremity paresthesia,and the symptoms were improved 1 weeks later;1 case with intraoperation puncture site paining was not alleviated and had to stop the puncture.All patients with CT guided biopsy had no complications.Conclusion CT and X-ray guided percutaneous biopsy has important significance in diagnosis and treatment of spinal lesions,and CT guided percutaneous biopsy is safer for thoracic lesions with higher diagnostic rate,while for lumbar lesions fluoroscopy,X-ray or CT guided percutaneous biopsy has the same security and diagnostic rate.
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Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA) on malignant lesions in gastrointestinal adjacent tissue, and further to analyze the risk factors influencing positive rate of EUS-FNA. Methods The clinical data of 171 patients undergoing EUS-FNA from January 2009 to May 2016 were collected. The lesion location, size and characteristics, the number of needle passes, puncture suction negative pressure, size of puncture needle, and years of operator experience in EUS were retrospectively analyzed. Results The overall sensitivity, specificity, and accuracy of EUS-FNA in the diagnosis of malignant lesions were 78. 3% ( 83/106) , 100. 0% ( 65/65) , and 86. 5%( 148/171) , respectively. The univariable logistic regression analysis demonstrated that the risk factors of EUS-FNA were lesion location, lesion characteristics, and lesion size. In multivariate analysis, larger lesion size ( OR=1. 029, 95%CI: 1. 011-1. 047, P=0. 001) and lesion characteristics of solid ( OR=5. 098, 95%CI:1. 324-19. 633, P=0. 018) were independent factors affecting the positive rate of EUS-FNA. Among 171 cases performed by EUS-FNA, the incidence of postoperative complications was 1. 75% ( 3/171 ) included 2 cases of fever and 1 case of acute pancreatitis, which were improved after conservative treatment. Conclusion EUS-FNA is a safe and effective method of cytological and histological diagnosis with high accuracy and sensitivity, importantly in distinguish malignancy from benign lesion in gastrointestinal adjacenttissue. Positive rate of diagnosis on malignant lesions by EUS-FNA is positively correlated with lesion size, and EUS-FNA positive rate of solid malignant lesions is significantly higher than that of cystic lesions.
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Objective To compare and explore the curative effects of elective operation and emergency operation in treating atlantoaxial vertebral segmental spinal canal space-occupying lesions.Methods Thirty-two patients suffering from atlanto-axial vertebral segmental spinal canal space-occupying lesions treated in our hospital from May 2010 to April 2015 were selected and divided into the emergency operation group (group A,n =14) and elective operation group (group B,n =18).The emergency and elective operations were adopted respectively.Then the operation time,intraoperative blood loss,JOA score,ODI index,VAS score,postoperative imaging(MRI) and effect satisfaction degree were compared between the two groups.Results After treatment,the JOA score in the group A was (25.23±4.47) points,which was higher than (22.10±3.56) points in the group B,and the difference was statistically significant (t=3.67,P<0.05).The ODI index and VAS score of the two groups all were decreased.The ODI index in the group A was (18.56±3.10) points,which in the group B was (21.56±4.37) points,and there was statistically significant difference between the two groups (t=3.76,P<0.05).The VAS score in the group A was (1.89 ±-0.53)points,which in the group B was (3.16±0.89)points,the difference was statistically significant between the two groups (t=3.76,P<0.05).Before surgery and at postoperative 1 month,the spinal cord function classification(Frankel grade) of the two groups had no statistically significant difference between the two groups(Z=-0.18,P=0.85>0.05,Z=-0.52,P=0.60>0.05).The operation time had no statistical difference between the group A and B[(120.23±9.02)min vs.(126.25±12.12)min,P>0.05].The intraoperative bleeding volume had had no statistical difference between the group A and B [(211.26±12.25)mL vs.(220.43±17.58)mL,P> 0.05].After one month of treatment,the satisfaction degree in the group A was 92.56 %,which was higher than 72.22% in the group B,and the difference was statistically significant (Z=-2.13,P<0.05).Conclusion Emergency operation in treating atlantoaxial segment spinal space occupying lesions can effectively improve the therapeutic effect,and has higher patients satisfaction after treatment.Therefore which is worth promoting and applying.
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Objective:To investigate the diagnostic value of MRI and CT for the liver space-occupying lesions.Methods:The clinical data of 70 cases of patients with liver space-occupying lesions in our hospital from June 2012 to May 2016 were divided into two groups and retrospectively analyzed.35 cases underwent contrast enhanced ct scans (CT group),and others underwent dynamic contrast-enhanced MR imaging(MRI group).The pathological diagnosis,number of lesions and lesions diameter were ompared between two groups.Results:No significant difference was found in the pathological diagnosis,number of lesions(71 vs 70) and lesions diameter(2.25 ± 2.01 cm vs 2.19± 1.98 cm) between two groups(P>0.05).As the gold standard by pathological diagnosis results,correct diagnostic rate of MRIgroup were 85.71%,which was 77.14% CT group and lower than that of the MRI group,but no significant difference was found between two groups (P>0.05).The incidence of adverse reactions in CT group was significantly higher than that of the MRI group (P>0.05).Conelusion:Both CT and MRI enhancement scanning have higher diagnostic value for the liver space-occupying lesions,but MRI enhancement scanning has higher safety and tolerability.
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AIM:To explore the histopathological classification and incidence of orbital space-occupying lesions in children in order to provide references for the diagnosis of orbital space-occupying lesions in children. METHODS:A total of 290 paediatric patients with orbital space - occupying lesions diagnosed by pathological examinations at the Second Hospital of Tianjin Medical University from January 1998 to December 2012 were retrospectively reviewed. RESULTS:In 290 paediatric patients with orbital space-occupying lesions, venous hemangioma was the most common (58 cases,20. 0%), the other commons were as follows: hemangio lymphangioma, dermid cyst, neurofibroma, optic nerve glioma, rhabdomyo sarcoma and so on. Capillary hemangioma, venous hemangioma, optic nerve glioma had the predominant age incidence. On the other hand, optic nerve glioma, venous hemangioma, rhabdomyosarcoma had the predominant sex incidence. CONCLUSION: The majority of paediatric patients with orbital space - occupying lesions are congenital and embryonic lesions, the most common of which is venous hemangioma. Some lesions had the predominant age and sex incidence.
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Objective To discuss the clinical and pathological features of malignant rhabdoid tumor of the ureter (MRTU).Methods One case of MRTU was reported, a six-year-old girl was admitted to our hospital on May 29, 2014, and presented left loin pain 2 weeks, ultrasound showed gradually progressing hydronephrosis and hydroureter.During a physical examination, she felt tenderness in the left kidney area and no mass was palpable in abdomen.The ultrasound showed left sided gross hydroureteronephrosis and a round hyperechogenic mass in the inferior pole of the left ureter (In front of the left iliac vessel), with no obvious borders.Contrast-enhanced CT suggested a gross dilatation of the left kidney and ureter with a solidappearing lesion in the lower ureter;neither additional abdominal abnormalities nor enlarged lymph nodes were seen in both examinations.The surgery began with incision of left lower abdomen.The partial ureter of neoplasm was excised along with invaded psoas and posterior peritoneum by gross inspection, then ureteroureterostomy was performed.The severed ureter was completely blocked with the ill-defined neoplasm and was 3.3 cm in length and 2.1 cm in width.Results The ureteral neoplasm was excised,along with the invaded psoas and posterior peritoneum,after that ureteroureterostomy was performed.HE showed the diffuse large round nuclei, vesicular chromatin, prominent nucleoli cells, and moderate amounts of eccentrically placed eosinophilic cytoplasm.Immunohistochemical studies were positive for cytokeratin, epithelial membrance antigen and vimentin, negative for INI1, METU hereby was confirmed.She underwent a chemotherapy regimen consisting of ICE, alternating with VDC.Four courses chemotherapy (3 months) later,CT scan suggested hematogenous metastasis of lung.The family refused further treatment and the patient died of systemic metastasis eight months after surgery.Conclusion MRTU was a rare and highly aggressive tumor with a poor prognosis.
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Left atrial space occupying lesions pose diagnostic challenge on echocardiography. We report a 79-year-old man with history of pheochromocytoma with left adrenal mass presented with heart failure symptoms after adrenalectomy. Echocardiogram revealed a large echo lucent structure (6.9 x5.9cm) compressing the posterior wall of the left atrium. Further investigation with computer tomography and barium swallow confirmed the diagnosis of hiatal hernia. In this report we explain the differential diagnosis and simple steps to assist the diagnosis of left atrial space occupying lesions noninvasively.
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Ultrasonography is safe, non- invasive, cost-effective, less time-consuming, easily repeatable and simple investigation for the diagnosis and follow up of intrahepatic space occupying lesions. In these study ninety patients with a probable diagnosis of space occupying lesions of liver were studied. The diagnosis of intrahepatic space occupying lesions was confirmed in eighty-two patients. Ultrasonography had sensivity of 91%.
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Adolescente , Adulto , Anciano , Biopsia con Aguja , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/diagnóstico por imagen , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Ultrasonografía , Adulto JovenRESUMEN
Objective To evaluate the value of the three dynamic contrast-enhanced scan with spiral CT in hepatic tu-bercular lesion. Methods Retrospectively 38 cases with hepatic tubercular lesions less than 5cm were studied , which were performed with the three dynamic contrast-enhanced scan with spiral CT in our hospital from Jun. 2010 to Mar. 2014. Results Ten cases of hepatocellular carcinoma were characterized by lower density in the venous and delay phase, and obviously enhanced in the arterial phase. 7 cases of liver metastases were characterized by less enhanced in the arterial phase, loop in the venous phase, lower density in the delay phase. 8 cases of hemangioma were charac-terized by tubercular in the arterial phase , concentric enhanced in the venous phase , equidensity in the delay phase. 3 cases of inflammatory pseudo tumors were characterized by less enhanced in the arterial phase , concentric en-hanced in the venous phase and delay phase. 1 case of tuberculoma were characterized by slightly loop especially in the venous and delay phase. Not enhanced in the all the phase for 9 cases of cysts. Conclusion The imaging of three dynamic contrast-enhanced scan with spiral CT are characteristic in mostly hepatic tubercular lesion , and could pro-vide reference to qualitative diagnosis.
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Objective To investigate the experiences in the diagnosis and treatment of space-occupying lesions of the head of pancreas.Methods The clinical data of 247 patients with space-occupying lesions of the head of pancreas who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2011 to April 2014 were retrospectively analyzed.All the patients received enhanced computed tomnography and (or) magnetic resonance imaging of the pancreas.The levels of alpha-fetal protein (AFP),CA19-9,CA125 and carcinoembryonic antigen (CEA) were detected,and the serum level of IgG4 was detected in patients who were suspected of autoimmune pancreatitis.Intraoperative pathological examination was applied to patients who were diagnosed as with cancer of the head of pancreas.Pancreaticoduodenectomy,extended pancreaticoduodenectomy or bilio-jejunostomy or (and) gastrointestinal anastomosis were applied to patients according to the stage and infiltration of the tumor.Duodenum-preserving pancreatic head resection or pancreaticoduodenectomy could be selected after informed consent.The adjacent tissues and organs should be preserved on the premise of complete tumor resection for patients with benign and low-grade malignancy.Results A total of 194 patients had solid spaceoccupying lesions of the head of pancreas,including 125 with pancreatic head cancer,45 with mnass in the head of pancreas,9 with chronic pancreatitis with mass in the head of pancreas,11 with autoimmune pancreatitis,4 with insulinoma.Fifty-three patients were with cystic space-occupying lesions,including 12 with mucinous cystadenoma,8 with serous cystadenoma,17 with pancreatic cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.The positive rates of AFP,CA19-9,CA125 and CEA of the 71 patients who were confirmed as with pancreatic cancer by pathological examination were 7.0% (5/71),94.4% (67/71),42.3% (30/71) and 0,respectively.The positive rates of AFP,CA19-9,CA125 and CEA of the 12 patients with chronic pancreatitis with mass in the head of pancreas were 1/12,4/12,1/12 and 0,respectively.Seventynine patients with pancreatic head cancer,mass in the head of pancreas and chronic pancreatitis with mass in the head of pancreas received intraoperative pathological examination.A total of 119 patients received operation,including 71 with pancreatic head cancer,7 with chronic pancreatitis with mass in the head of pancreas,4 with insulinoma,1 with pancreatic tuberculosis,8 with mucinous cystadenoma,4 with serous cystadenoma,6 with pancreatic pseudocyst,1 with huge lymphangioma,1 with lymphoepithelial cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.Of the 247 patients with space-occupying lesions of the head of pancreas,61 received pancreaticoduodenectomy,4 received duodenum-preserving pancreatic head resection,4 received pancreatic head and neck resection,2 received partial resection of the uncinate process of the pancreas,9 received enucleation of the tumor,38 received bilio-jejunostomy or (and) gastrointestinal anastomosis,22 received endoscopic retrograde cholangio-pancreatography + stent installation,18 received percutaneous transhepatic cholangial drainage + stent installation,1 received exploratory lapartomy and the other 88 patients were untreated.Conclusions The diagnosis and differential diagnosis of the space-occupying lesions of the head of pancreas depend on the clinical presentation,medical history,laboratory examination,sonography,computed tomography or magnetic resonance imaging.Individualized treatment plan based on the feature of the tumor and kinds of the lesions combined with intraoperative pathological examination is helpful for selecting the surgical procedures.
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The need of pathological diagnosis of spaceoccupying lesions of the head of pancreas before pancreaticoduodenectomy is a hot issue in the pancreatic surgery.According to the present guidelines and consensus,pathological diagnosis is not required if the patient with clinically resectable space-occupying lesions of the head of pancreas.However,confirmation of tumor malignancy is mandatory for patients with borderline resectable disease to be treated by neoadjuvant therapy,for patients with unresectable tumors to be treated by chemoradiotherapy,and for patients with unresectable tumors to be treated with a palliative bypass procedure during the surgical exploration.When making a clinical decision,surgeons should fully communicate with the patients and their relatives,under the direction of a multidisciplinary team,and have a correct and dialectical knowledge of the guidelines and consensus.This would be helpful for the improvements of the diagnosis and treatment of space-occupying lesions of the head of pancreas.
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Objective To investigate the diagnosis and treatment of splenic space occupying lesions associated with comorbidity.Methods The clinical data of 5 patients from Jiangyin People' s Hospital and 9 patients from Wuxi People's Hospital from January 2002 to June 2012 were retrospectively analyzed.All the patients suffered from splenic space occupying lesions associated with comorbidity.Splenectomy or multi-visceral resection were selected according to the results of preoperative B sonography and computed tomography examination.Chemotherapy regimes were selected based on postoperative pathological examination.All the patients were followed up till June 2013.Results The symptoms of patients with splenic space occupying lesions were non-specific.The first symptoms of 4 patients were discomfort or distending pain of left upper abdomen,and the other 10patients had no symptoms.The coincidence rate of preoperative diagnosis was 10/14,and the coincidence rate of preoperative diagnosis for patients with malignant tumors was 2/5.Fourteen patients received preoperative B ultra-sonography,and 9 were definitively diagnosed.Nine patients received computed tomography,and 7 were definitively diagnosed.Of the 14 patients,right ovarian cancer,bilateral ovarian cancer and sigmoid colon cancer were correlated with solitary splenic metastasis,and the main lesions of the other 11 patients were not correlated with splenic space occupying lesions.The main lesions of patients with left colon carcinoma,type 2 diabetes and vascular tumor of the spleen,patients with renal carcinoma and splenic sclerosing hemangioma,and patients with hypertension,cholecystolithiasis and splenic lymphangioma were diagnosed simultaneously with the splenic space occupying lesions,and the main lesions of theother 11 patients were diagnosed separately with the splenic space occupying lesions.Ten patients underwent simple splenectomy and 4 patients received multi-visceral resection.Chemotherapy regimens were selected according to the type of main lesions for 5 patients who were diagnosed by pathological examinations.All the patients were recovered smoothly with no occurrence of severe infections.Two patients with splenic sarcoma had tumor metastasis at postoperative 6 months and 1 year,respectively.One patient with right ovarian cancer and solitary splenic metastasis had transverse colonic metastasis at postoperative 3 years.One patient with bilateral ovarian cancer and solitary splenic metastasis had peritoneal metastasis at postoperative 2 years.One patient with sigmoid colon cancer and solitary splenic metastasis died of peritoneal tumor recurrence at postoperative 4 years.One patient with left colon carcinoma,type 2diabetes and vascular tumor of the spleen survived for 6 years and was still sound and well.The other 9 patients with benign disease survived within the period of follow-up.Conclusions The definitive diagnosis for patients with splenic space occupying disease associated with comorbidity depends on the preoperative imaging examination and postoperative pathological examination.Surgical treatment is safe when operative contraindications are excluded.The prognosis of patients is determined by the progress of main lesions and the character of splenic space occupying lesions.
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PURPOSE: The purpose of this study is to present our clinical results after surgical treatment in tarsal tunnel syndrome due to space occupying lesions. MATERIAL AND METHODS: We performed surgical decompression for tarsal tunnel syndrome in 20 patients from July 2004 to February 2007. Out of them, thirteen cases were due to space occupying lesions around the tarsal tunnel. The average age at operation was 51.3 years old and the duration from symptom onset to surgery was 16.5 months. The operation included removal of space occupying lesions and tarsal tunnel decompression. The clinical parameters were pain visual analogue scale (VAS), AOFAS scale, and subjective satisfaction. RESULTS: The ganglion cysts were the most frequent causes (ten cases) and synovial chondromatosis in 1 case, neurofibroma in 1 case, talocalcaneal coalition in 1 case. The average follow-up duration was 14.5 months. The AOFAS scale showed significant improvement from 77.8 to 92.7. The average VAS decreased from 6.4 to 2.2. Seven out of thirteen patients were satisfied with the results. The excellent results were shown in six patients, the good results in one patient, the fair result in three patients and the unsatisfactory results in three patients. CONCLUSION: Favorable results could be obtained in patients with known etiology. But not all cases with surgical decompression of space occupying lesions showed satisfactory results. We assume that the clinical results were related to the multiple factors, not only well performed surgery but also age, size lesions and duration of symptoms, ect.
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Humanos , Condromatosis Sinovial , Descompresión , Descompresión Quirúrgica , Estudios de Seguimiento , Ganglión , Neurofibroma , Síndrome del Túnel TarsianoRESUMEN
Multiple intracerebral space-occupying lesions (SOL) demonstrated by computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide brain scanning or cerebral arteriography often present a diagnostic enigma. The differential diagnosis between brain abscess and brain tumor is occasionally difficult to determine on the basis of imaging studies and clinical judgement, especially in the case of brain SOL with mainly cystic or necrotic component. Elderly patients with a history suggestive of hidden malignancy and the above radiological features are usually presumptively diagnosed as having multiple cerebral metastases. We experienced a case of multiple brain abscess which was confirmed by diagnostic surgery, in a 67- year old male who showed clinical and radiological findings of mimicking cystic brain metastases with undetermined primary focus. Even with long-term therapy with antibiotics and supportive care, the patient suffered from massive ventriculitis and subsequently died.