Urothelial Ca revealed by a solitary CNS metastasis: an unus
A 50-year-old smoking man was admitted in the neurosurgery department for slow progress onset of holocranial headaches resistant to medical treatment and evovlving since more than 12 months with recently installation of vomiting and bilateral visual blur 3 days before his admission without epilepsia or another localization sign.

Neurological examination showed no motor palsy except a left facial hypoesthesia and right lateral homonymous hemianopia. The fundus examination was without abnormalities.

A CT scan was performed revealing intra axial parieto-occipital lesion mesearing 45 mm of long axis which is hypodense and unenhanced in its center with thick enhanced wall and having intensely enhanced left anterolateral focal thickening. This lesion was surrounded by important edema with mass effect on cortical grooves and the left occipital horne of the homolateral ventricule.

The patient underwent a total remove of the lesion through a parieto-occipal bone flap. The lesion was friable and haemorrhagic with no obvious healthy boundaries.

The histopathological examination demonstrated a proliferation of papillary structures centered by a conjonctivo-vascular axis and lined by several layers of cells of transitional appearance with nuclear atypies. The immunohistochemistry was positive for only cytokeratine 7 (Ck7). This aspect is compatible for a metastasis of high grade urothelial papillary carcinoma.

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