Neurological Surgery No Shinkei Geka Volume 45, Issue 4 (April 2017)

A Case of Slowly Progressive Brain Metastasis with Minor Bleeding after Removal of and Chemotherapy for Non-Small Cell Lung Cancer Hiroshi MATSUFUJI 1 , Eri SHIOZAKI 1 , Yasutaka NAKATAKE 1 , Koichi YOSHIDA 2 , Kensaku KAMADA 2 , Takayuki MATSUO 2 1Sixth grade student of Nagasaki University School of Medicine 2Department of Neurosurgery, Nagasaki University Hospital Keyword: slow progressive metastatic brain tumor , non-small cell lung cancer(NSCLC) , cavernous hemangioma , PET pp.339-344
Published Date 2017/4/10
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 Of all brain metastases, the most common primary lesion is derived from the lung. These types of metastases enlarge aggressively with unfavorable prognoses. We report the case of a 75-year-old male patient who had a history of pulmonary resection for Stage IA non-small cell lung cancer(NSCLC), and received chemotherapy. One year after NSCLC surgery, he experienced a cardiogenic cerebral infarction, and anticoagulant therapy was initiated. Mass lesions with hemorrhage were detected bilaterally in the frontal lobes through magnetic resonance imaging three years after the NSCLC surgery. The lesions slowly enlarged during follow-up. However, there were no clinical symptoms. There was no finding indicating a local recurrence or metastasis through positron emission tomography(PET). Two and a half years after the detection of the lesion, left hemiplegia was observed. Massive hemorrhage from the right frontal lobe lesion was observed on computed tomography(CT). Craniotomy and evacuation of the hematoma were performed. The histopathological findings showed adenocarcinoma and the diagnosis was brain metastasis of the lung cancer.

 This case reveals brain metastasis of lung cancer that progressed without extracranial metastases for three years. The brain tumor enlarged, accompanied by hemorrhage, extremely slowly without any symptoms. It was difficult to differentiate between metastasis and cavernous hemangioma, considering the extremely slow progress and image analyses. Of the reported prognostic factors associated with postoperative brain metastasis from surgically resected NSCLC, three factors were applicable to this case:adenocarcinoma, a small number of brain metastases, and the absence of extracranial metastases at the diagnosis of brain metastasis. We should consider the possibility of a metastatic brain tumor secondary to lung cancer even long after thoracic surgery.

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Neurological Surgery 脳神経外科
45巻4号 (2017年4月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院