悪性胸膜中皮腫の硬膜転移による急性硬膜下血腫の1例

A Case of Acute Subdural Hematoma due to Dural Metastasis from Malignant Pleural Mesothelioma

I．はじめに

　急性硬膜下血腫は，多くの場合，重傷頭部外傷に伴って生じるが，時に脳動脈瘤，脳動静脈奇形などの血管障害^3）や腫瘍性病変^23），血液凝固異常^21），特発性の出血^11）による報告も散見される．しかしながら，悪性腫瘍の硬膜転移に起因する急性硬膜下血腫の報告は文献上1例のみである^23）．

　今回われわれは，悪性胸膜中皮腫の硬膜転移により急性硬膜下血腫を来した1例を経験したので若干の文献的考察を加え報告する．

A rare case of acute subdural hematoma due to dural metastasis from malignant pleural mesothelioma is re-ported.

A 65-year-old man was brought to a nearby hospital complaining of lumbago. He suddenly complained of headache on the third hospital day and fell into a deep coma within a short while. Computed tomography showed a crescent shaped high density area in the right fronto-temporo-parietal region with midline shift to the left side. He was admitted as an emergency case to our clinic on April 24, 1989. Under the diagnosis of acute spontaneous subdural hematoma, emergency operation was performed. Nests of malignant sarcomatous cellswere found in the clot obtained during the procedure, but the origin of the tumoral cells could not be identi-fied. The patient failed to recover from the comatous state and died with pancytopenia on the 17th hospital day. General autopsy showed wide-spread malignant pleural mesothelioma with metastases to the lung, liver and bone marrow. Examination of the head revealed dural metastatic tumor and a subdural hematoma over the left hemisphere. Histopathology showed that many tumor cell nests were found only within the dilatedveins of the dura. There, acute subdural hematoma was assumed to have developed suddenly and there was massive bleeding from the capillaries of the inner vascular layer of the dura.

The relevant literature about intracranial metastasis of malignant pleural mesothelioma was reviewed, and the mechanism of subdural hematoma due to dural metastasis from malignant tumor was discussed.