脈絡叢に限局性転移を示した腎細胞癌の1症例

Renal Cell Caricinoma Metastasizing to Choroid Plexus of Lateral Ventricle; A case report

I．はじめに

　脈絡叢部に発生する腫瘍としては，乳頭腫，髄膜腫，血管腫，海綿状血管腫，リンパ腫等が挙げられる^11,24）．転移性腫瘍も稀ながら剖検例では2.6％の頻度でみられるとされ^19），鑑別診断上考慮に入れる必要がある．この場合多発性脳転移の一病巣として捉えられたものが殆どであり^6,19），孤立性転移を示した報告は極めて少ない^4,6，22）．今回著者らは，側脳室体部の脈絡叢に限局性転移を示した腎細胞癌の稀な一症例を経験した．症例の詳細を示し，若干の文献的考察を加え報告する．

A rare case of renal cell carcinoma metastasizing to the choroid plexus of the lateral ventricle is reported. A 59-year-old woman was admitted to our institution on November 26, 1987 complaining of left-half headachefor one month. She had a past history of right nephrec-tomy due to renal cell carcinoma 4 years before admis-sion, and of right radical mastectomy due to breast can-cer 10 years before admission. She had no abnormal neurological findings and laboratory results were nor-mal. CT scan revealed a well-circumscribed, apparently homogenously enhancing mass in the left lateral ventri-cle with mild ventricular dilatation. Left vertebral angiogram showed a tumor stain fed by the left pos-terior choroidal artery. The most likely diagnosis was thought to be metastasis of renal cell carcinoma. The patient underwent the operation for tumor removal via the posterior interhemispheric transcallosal approach 14 clays after admission. A histological examination of the tumor determined the diagnosis of clear-cell type renal cell carcinoma. The operation was uneventful and the patient was discharged 20 clays after operation without neurological deficit. But she had recent-memory dis-turbance, low activity, and gait disturbance in May 1989. CT scan revealed ventricular dilatation and tumor recurrence at the same site. She also suffered from di-abetes clue to the regrowth and invasion of primary tumor to the pancreas. She was discharged free of neurological defects after ventriculo-peritoneal shunt. In December 1989, she gradually deteriorated due to the regrowth of the intraventricular metastatic lesion, and now she is bedridden. Choroid plexus metastasis is quite rare, and, to our knowledge, only three cases have been described.