小脳テントに転移して発症したAFP産生胃癌

AFP Producing Gastric Cancer Manifested by Metastasis to the Tentorium Cerebelli; Case report and review of the literature

I．はじめに

　癌症例における単発性硬膜転移は，比較的まれであるが，乳癌や肺癌の剖検において時々発見されるようである．今回われわれは，小脳テントというきわめてまれな部位に転移して発症した，AFP産生胃癌を経験したので，文献的考察を加えて報告する．

We report a case of AFP producing gastric cancer manifested by metastasis to the tentorium cerebelli. A 66-year-old male patient was admitted with dysarthria, occipital headache and nausea on May 1, 1990. Neuro-logical examination revealed signs of increased intracra-nial pressure and the right-sided crebellar hemispheric signs. CT and MRI showed a round tumor shadow 3cm in diameter, which originated in the right-side tentor-ium cerebelli and grew in the posterior fossa. Tumor stains fed by the right tentorial artery were recognized by angiography. Serum AFP level was 503.5ng/ml. The patient underwent an operation under general anesthesia in the prone position. The tumor was totally removed via the suboccipital transtentorial approach. Histological examination revealed AFP producing ade-nocarcinoma.

The patient was found to have a gastric cancer after neurosurgical operation, and underwent subtotal gas-trectomy by surgeons. Serum AFP level was 254.5ng/ ml after removal of metastatic brain tumor, and 5.0ng/ ml after subtotal gastrectomy.