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Dr. Mark
Dr. Mark, Physician / Surgeon
Category: Medical
Satisfied Customers: 13864
Experience:  U.S. Surgeon / Neurological Surgery
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I'd like to talk to a this possible?
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I had a brain mri and got my report back...just have a couple questions about it
JA: Anything else in your medical history you think the doctor should know?
Customer: History of breast cancer...had a brain mri because of some dizziness and other weird symptoms. I have a question or two about a finding.
JA: Are you keeping a personal medical record while dealing with this?
Customer: yes

Hello -

I'm a neurosurgeon and should be able to help you.

Do you have the report?

Customer: replied 5 months ago.
I do...I had an mri done and the following is what it said...
Customer: replied 5 months ago.
Under Findings, it said for the Cerebral Parenchyma: There is no enhancing mass identified within the brain parenchyma. There are no areas of cortical edema. There is no infarction. There is no intracranial hemorrhage. There is a 3.6 mm tiny focus of FLAIR hyperintensity in the centrum semioviale. This area does not enhance. It is non specific.
Customer: replied 5 months ago.
For Impression it said: no metastatic focus identified. There is a tiny non specific FLAIR hyperintense focus and this may be within normal limits for age.
Customer: replied 5 months ago.
I am 49 years old. I was treated for breast cancer in 2016/2017 and was stage 3a ...had complete response to chemo.
Customer: replied 5 months ago.
My oncologist wants to do a follow up after 6 months to be diligent but doesn't seem hugely concerned. I'm of course anxious and have a few questions...


No tumor, no swelling, no stroke, no bleed.

The tiny area of FLAIR hyperintensity -- means there is a small white dot on your MRI in the specific area of the brain -- but a single small area that does not enhance (which makes a tumor and infection much less likely) is not really of a concern.

A breast cancer issue in the brain would generally cause swelling and enhancement of the tumor. The FLAIR hyperintense focus is not a tumor.

People often get these "white spots" as they get older, and it can be a result of high blood pressure, high cholesterol, migraines over years affecting parts of the brain, causing these changes.

The MRI is not concerning for cancer.

Customer: replied 5 months ago.
Thank you so are my questions
Customer: replied 5 months ago.
do you see these spots in 49 year olds or is that more rare?
Customer: replied 5 months ago.
I have read that some tumours are non enhancing until they are larger. Is 3.6 mm large enough to create some of the features you allude to - edema, vasculature so that there is enhancement, etc.? I'm concerned that it's so small that tumour features haven't shown up yet.

Yes, we can see those in 49 year olds.

Most people have something like this, and by the time people turn 60 or 70 - most people have multiple spots like this.

Customer: replied 5 months ago.
Is it common for an oncologist to order a follow up? The request for follow up sort of threw me off, as though there is a question mark around this report

Small tumors may not enhance, as there may not be enough blood vessels to "light" up the tumor. So, theoretically, a tiny area of tumor can be missed by the MRI.

Oncologists will usually order some type of followup (why did they get the MRI in the first place?).

Customer: replied 5 months ago.
in a report like mine, what are the odds of this being a tumour in the other words, how often would a report like mine with a history like mine mean something else?
Customer: replied 5 months ago.
She got the MRI because I was complaining of a variety of symptoms...headached, equilibrium being off, a bunch of nerve things (twitching, burning patches, itching), etc. I had a bit of autoimmunity show up years ago and I wondered if this stuff could be related to that. But my MO ordered up the brain mri because of my head complaints.

If you did not have a history of breast cancer -- I would have zero concern.

With the history of breast cancer -- one has to be vigilant about possible spread of the cancer -- but the spot on the MRI is not one of concern to me, since there was no enhancement or swelling in that area. Even at 3mm, some enhancement in that area would have been concerning. To see no enhancement is reassuring.

OK - nothing on the MRI would be the cause of the headaches or other symptoms.

Customer: replied 5 months ago.
Up top, you said the report is not concerning for cancer and that breast cancer metastasis to the brain would cause edema. Would you expect that with a 3.6 mm lesion? Overall, how worried should I be with this report given my background? I realize nothing is totally concrete, but it would be nice to know your thoughts on probabilities based on your experience...tx
Customer: replied 5 months ago.
oh, sorry, just seeing your last response now
Customer: replied 5 months ago.
would you expect edema at 3.6 mm?

If the 3.6 mm was a tumor, one would expect to see some edema around the lesion on the other sequences, like the T2 sequence.

So the fact they did not see anything on that picture is reassuring.

Customer: replied 5 months ago.
Oh, and enhancement. Is enhancement usually seen at this size? I understand that certain types of tumours don't enhance at all - so that freaks me out too.

If this is a breast cancer -- it should enhance.

Some type of tumors don't enhance -- like low grade gliomas -- but that would not show up like this.

Customer: replied 5 months ago.
Oh, I see...I don't know what kind of brain tumours you get with breast cancer.
Customer: replied 5 months ago.
just out of curiosity, how WOULD a low grade glioma show up?
Customer: replied 5 months ago.
OK, so in this point I should feel fairly ok? Would you say it's low odds that this is a tumour? I just want to know how to frame my mind for the next 6 months!

A low grade glioma would not enhance, and often can't be seen very easily on the MRI, but one side of the brain can look more "plump" than the other.

At this point you should feel OK. This, by your description on the report is not a tumor. There is nothing concerning on the report to say this is a tumor.

Customer: replied 5 months ago.
I'm guessing you've seen a lot of brain mets via breast cancer? I really appreciate your feedback and insights. I like to understand things deeply and of course there's the anxiety...
Customer: replied 5 months ago.
Oh, and by the way...I don't smoke, have low blood pressure, have no migraines (just the funny autoimmune looking stuff).

Yes, I have seen hundreds of MRIs with tumors, and they generally are very obvious on the imaging scan.

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Customer: replied 5 months ago.
3.6 mm isn't too small to get some clear features? Thanks very much. That is my last question and I will now offer my rating. I appreciate your detailed feedback to my question!

3.6 mm isn't too small to see enhancement -- so the lack of enhancement in this area is the most reassuring sign that this is not a spread of breast cancer to this area.

Customer: replied 5 months ago.
Thanks very much for your time!

Best of luck to you.

Customer: replied 5 months ago.
Thanks so much
Customer: replied 5 months ago.
I received an email asking if I'm done with my question and actually have a couple more questions that I didn't think of...
Customer: replied 5 months ago.
Is it possible for me to ask these?
Customer: replied 5 months ago.
OK - if I may ask my questions? I am being told you're online and available to chat, but not by phone..My questions are:
1. I had a CT scan of my brain almost 2 years ago and almost 1 year ago (two times). In both cases, there were no notes about any spot of hyperintensity (or whatever it would look like on CT scan). Should a CT scan show this little spot if it was there a year ago?
2. I had an exchange with a neuroscientist who wrote a book and had melanoma that went to her brain. When she was applying to be in an immunotherapy trial, they did an MRI of her brain and they weren't sure what three spots were. When I asked her about this, she said that you can't tell reliably from MRI what something is. She went on to say she's not a clinician and I should follow up with my Oncologist (which of course I have). So this made me wonder...with what I shared with you, how often is that a 'false negative'? Is it fair to say that there is a lot of vagueness around what they saw in my report? I'm now wondering based on her comment re: reliability.
I hope it's ok to ask a couple more questions. I received a notification from justanswer and then was directed back to this page...tx
Customer: replied 5 months ago.
Hello, I have not heard back from anyone, but I was asked by notification on Sunday if I had anything else to ask to finish up my question? I would appreciate a follow up - thanks very much

Hello - I couldn't previously answer the question because it wouldn't allow me to do so.

But now I can, so:

1) the CT scan would not show these types of spots -- MRI would be needed for comparison from a year ago. A normal CT of the brain from two years ago doesn't mean that this "spot" wasn't there at the time.

2) these spots are very common - and it is true -- if something is 3mm in size, there really isn't a way to be 100% sure about anything. Could it be a small tumor, which is growing, but the MRI caught it at the early stages? Possibly, but the likelihood of this is very small, and it didn't enhance on the MRI. The common things are common, and it is very likely that this is just what it looks like - a "spot" that is commonly seen in many people's brain that has nothing to do with cancer.