17 August 2026
: Case report 
A Case Report of a 64-Year-Old Man With Urothelial Carcinoma With Brain and Leptomeningeal Metastases Treated With Intrathecal Methotrexate as Part of Multimodal Management
Unusual or unexpected effect of treatment, Rare disease
Leland F. Damron ABCDEF 1, Leigh Kinney ADEF 1, Nikhita Kathuria-Prakash ADEF 2, Marilena Iliopoulos EF 3, Dimitrios Stefanoudakis EF 4, Lidia P. Lopez BDEF 2, Marah Sakkal
BE 5, Negar Khanlou BCD 6, Steven D. Hart BCD 6, Neda A. Moatamed BCD 6, Nicolaos J. Palaskas AEF 2, Alexandra Drakaki ACDEG 2,4*
DOI: 10.12659/AJCR.951572
Am J Case Rep 2026; 27:e951572
Figure 2 Radiologic progression of metastatic disease. (A) Computed tomography (CT) of the chest without contrast showing a newly enlarged 4-mm solid pulmonary nodule in the left lower lobe, suspicious for metastatic disease. (B) Contrast-enhanced magnetic resonance imaging (MRI) of the brain (axial T1-weighted post-contrast sequence) demonstrating a rim-enhancing cystic lesion in the right parietal lobe (posterior lesion), measuring 52×36 mm with no significant surrounding edema, with associated mass effect of the right ventricular trigone. In addition, a solid enhancing mass was visible in the right anterior frontal lobe measuring 13×15 mm, surrounded by vasogenic edema.