結腸及び直腸重複癌に併発した横静脈洞血栓症の1例

Transverse Sinus Thrombosis in a Patient with Colon and Rectal Double Cancers:A case report

I．はじめに

　他臓器に悪性腫瘍を担う患者が，脳静脈洞血栓症の併発により皮質下出血を来たした場合には，その所見が転移性脳腫瘍による腫瘍内出血と酷似し，診断が困難となる場合がある．今回われわれは，結腸及び直腸重複癌に横静脈洞血栓症による側頭葉皮質下出血を合併した症例を経験したので，その特徴と鑑別診断について文献的考察を加えて報告する．

We report a case of transverse sinus thrombosis accompanied by colon and rectal double cancers. A 48-year-old male transferred to our department from the division of surgery due to deterioration manifested by headache after colectomy and low anterior resection of the rectum. There was bilateral papilledema and right upper homonymous hemianopsia. On admission all the laboratory data were within normal range. CT showed a left temporal mass lesion of heterogenous density, which was suspected as being intratumorous hematoma in a metastasis. MRI revealed a left transverse sinus thrombosis. The left transverse and sigmoid sinuses were not opacified, but angiography showed that the occipital and marginal sinuses seemed to be markedly developed.

Evacuation of the subcortical hematoma was carried out. Histologically, it was a mixed hematoma in acute and chronic stages without any carcinoma component or vascular malformation. Postoperative course was un-eventful, and the patient was returned to the division of surgery in order to follow up the cancer 2 weeks after operation. Angiography 4 months after operation showed almost no recanalization in the left transverse sinus. Further, development of the collateral flow and the double occipital sinus was opacified.

Because the coagulation system is often activated by the presence of cancer, it is important to distinguish in-tracerebral hemorrhage due to sinus thrombosis from intratumorous hemorrhage within a metastatic tumor