脳転移を来たした副腎皮質癌の1例

Central nervous system metastasis from non-functioning adrenocortical carcinoma:report of a case

I．はじめに

　副腎皮質癌は日本病理剖検輯報で全悪性腫瘍の0.15％というきわめて稀な腫瘍であり，腫瘍の産生したステロイドにより，その過剰症状を呈する‘内分泌活性癌’と，ステロイドを合成しない‘内分泌非活性癌’とに分けられる．剖検時における臓器別の転移頻度は活性癌および非活性癌とも約半数以上に肺，肝に転移が発見され，中枢神経系への転移は15％と報告されている^11）．しかし文献的には，副腎皮質癌の脳転移に関して剖検例3例，臨床例3例の計6例の報告^{2,6,10,12,16,19）}があるに過ぎず，詳細な画像診断を含む臨床経過の報告例は全くない．今回われわれは，副腎皮質癌が肺の遠隔転移とともに脳転移を来たした症例の診断，治療を行う機会を得たのでその詳細を報告し，若干の文献的考察を加える．

We report a rare case of brain tumor metastasizing from an adrenocortical carcinoma. A 47-year-old man was referred to our department on September 21, 1995, with complaints of episodic loss of consciousness and severe left motor weakness. There was a past history of left adrenalectomy performed in the Department of Surgery of our hospital 9 months before. On admission, computed tomography (CT) and magnetic resonance imaging (MRI) revealed two well circumscribed masses in the right frontal lobe with peritumoral, marked brain edema and metastasis to the lung. The brain tumor was successfully removed via frontal craniotomy 4 days af-ter admission. Histological examination of the tumor specimen revealed metastatic anaplastic cell carcinoma, indicating metastasis from an adrenocortical carcinoma. After chemotherapy with cisplatin, pepleomycin and pirarubicin, he was discharged without neurological de-ficit. Two months postoperatively, however, the patient received 50 Gy of telecobalt radiation therapy to the whole brain because of recurrence. Three months after-wards, the patient returned complaining of general fati-gue. Chest CT scan revealed further enlargement of the lung lesions. Despite repeated chemotherapy, the pa-tient died of lung metastases eight weeks later. Central nervous system metastasis from adrenocortical carcino-ma is exceedingly rare. To the best of our knowledge, only 5 cases have been reported. We report here another case of brain metastasis from adrenocortical carcinoma possibly via lung metastasis, and review the pertinent medical literature.