同時多発性脳内出血で発症した転移性脳腫瘍の1例

Metastatic Brain Tumors with Simultaneous Multiple Cerebral Hemorrhages: A Case Report

Ⅰ．はじめに

　癌に対する治療法の進歩により，担癌患者の生存期間が延長するとともに転移性脳腫瘍の発生も増加傾向にある⁷⁾．転移性脳腫瘍患者の予後に影響を及ぼす合併症として腫瘍性脳内出血が挙げられるが¹³⁾，実際にはその頻度は低く，稀である^2,5,23)．また，多発性転移性脳腫瘍では出血も多発する頻度が高いとされるが¹³⁾，そのほとんどが時期を異にして生じた出血であり，転移性脳腫瘍を原因として同時かつ多発性に脳内出血が発生した症例の報告は非常に少なく，病理学的検討を含めた詳細な報告は過去になされていない．

　われわれは同時多発性脳内出血で発症し，剖検による詳細な検討を行った腎細胞癌の脳転移症例を経験したので報告する．

　We encountered a case of multiple metastatic brain tumors with simultaneous multiple cerebral hemorrhages. A 45-year-old male suffered from sudden left hemiplegia and was admitted to our hospital. CT scans on admission revealed multiple cerebral hemorrhages with surrounding brain edema in the right frontal lobe,left frontal lobe,right occipital lobe and right basal ganglia. On full-body examination,renal cell carcinoma of the left kidney and multiple metastatic tumors in the lung,liver and vertebral body were identified. We continued conservative therapy,but the patient's condition worsened and he died 36 days later. The autopsy findings indicated that all hemorrhages had occurred in the necrotic tissue associated with the metastatic brain tumors. Simultaneous multiple cerebral hemorrhages caused by metastatic brain tumors are very rare, and the differential diagnosis of cerebral hemorrhage due to metastatic brain tumor and hypertensive cerebral hemorrhage is difficult. The present case indicates that metastatic brain tumor should be taken into consideration in cases with simultaneous multiple intracerebral hemorrhages.