腹膜原発漿液性表在性乳頭状腺癌の脳転移の1例

A Case of Serous Surface Papillary Carcinoma of the Peritoneum Metastatic to the Brain

Ⅰ．はじめに

　腹膜原発の表在性漿液性乳頭状腺癌（serous surface papillary carcinoma：SSPC）は卵巣原発SSPCと病理学的に同一の癌組織が腹膜に発生する悪性腫瘍である^1,6,8)．

　われわれは腹膜原発SSPCの脳転移例を経験した．かつては予後不良とされていたが^2,3)，化学療法の進歩により生存期間の延長例も報告されるようになり^1,5,7)，結果として脳転移例も増加することが予想され^5,7,9)，文献的考察を加え報告する．

　A case of brain metastasis from peritoneal serous surface papillary carcinoma (SSPC) was reported. This 68-year-old woman was admitted to our department because of decreased consciousness level for the last few days. Her medical past history revealed breast cancer and SSPC of the peritoneum at the age of 64. On admission she was comatose and irritable. Serum and urine examination revealed the syndrome of inappropriate secretion of antidiuretic hormone that was treated with strict restriction of water intake. MRI of the brain demonstrated a nonspecific mass in the subcortical area of the right superior parietal lobule. The mass was successfully removed in en bloc fashion. Pathological diagnosis was SSPC that was compatible with the previous diagnosis obtained from the peritoneum four years previously. Although the patient received whole brain radiation therapy postoperatively,her condition deteriorated rapidly. She died four months after brain surgery.

　SSPC of the peritoneum is a rare malignant tumor that is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary,diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. Because of the prolongation of survival resulting from advanced chemotherapy for SSPC of the peritoneum,more patients live long enough to develop brain metastasis. Therefore,SSPC of the peritoneum should be kept in mind in the differential diagnosis of a primary site for brain metastasis.