比較的長期間軽微な症状で経過した肺癌の脳転移，癌性髄膜炎の1例

A slowly progressed case of brain metastasis and meningeal carcinomatosis from lung cancer

I．はじめに

　悪性腫瘍の中枢神経系への転移の中でも，癌性髄膜炎は治療困難で予後不良である．今回報告する症例は肺癌からの脳転移および癌性髄膜炎であるが，脳転移巣の摘出，脳室腹腔シャント術後，癌性髄膜炎に対する放射線化学療法などを行わなかったにもかかわらず，1年以上の期間有為な日常社会生活を送り得たものである．癌性髄膜炎の経過としてはまれなものと考えられたので，若干の文献的考察を加えて報告する．

We reported a case of long survival brain metastasis and meningeal carcinomatosis from lung cancer without radiochemotherapy. A 59-year-old female admitted to our hospital suffered from headache, anorexia and nausea. Papilledema was noticed, and examinations showed a brain tumor in the left parietal lobe and can-cer cells in cerebrospinal fluid. Removal of the tumor and ventriculoperitoneal shunt were performed. Pathol-ogy showed adenocarcinoma. No neurological deficit was found during the postoperative course and the pa-tient asked for home treatment. She survived for 25 months and spent a useful life in the 15 months after the onset in spite of no radiochemotherapy for menin-geal carcinomatosis.

In this case, because of the slow progression of the clinical symptoms, it is considered that cancer cells in the cerebrospinal fluid space grow slowly. The first CT and MRI findings of metastatic tumor of this case showed atypical for brain metastasis. Calcifications were found in plain CT and a high intensive tumor in both T1 and T2 weighted images of MRI. Enhance-ment due to contrast media was very slight in both CT and MRI. We considered that these findings were re-lated to the slow growing of cancer cells.