転移性脳腫瘍による多房性慢性脳内血腫の1剖検例

Multilocular Chronic Intracerebral Hematoma due to Metastatic Brain Tumor : a case report

I．はじめに

　慢性脳内血腫の報告例は文献上散見されるが，多くは慢性期に発見されて手術を施行されている例であり，初回出血時より長期経過を報告した例は少ない．今回われわれは基底核部脳内出血にて発症し，途中まで血腫は吸収傾向を示しながら，その後増大傾向を示し，さらには急激に血腫が多房性に巨大化した症例を経験した．剖検の結果より，肺癌が原発である転移性脳腫瘍からの出血であることが確認された．転移性脳腫瘍が原因の慢性脳内血腫は稀であり，さらに多房性の血腫も稀な病態であることから，経過及び剖検所見を中心に，若干の文献的考察を加え報告する．

Chronic intracerebral hematoma is a fairly rare clinical entity. We report a case of a 76-year-old manwho presented with left hemiparesis on admission. CT scan revealed a hematoma in the right basal gan-glia. Under observation, the hyperdense lesion on CT scan changed to isodense 2 weeks after admissionand then changed to lowdensity 4 weeks after the first scan. These findings suggested hypertensive in-tracerebral hemorrhage but, 3 months after admission, hemiparesis grew worse and the appearance of thelesion changed from lowdensity to isodensity again. When the patient presented disturbance of conscious-ness, CT scan revealed a new hemorrhage from the capsule of the hematoma and the new hematomamarkedly expanded 2 weeks later. The contents of the hematoma was old uncoagulated hematoma resem-bling chronic subdural hematoma and drainage was carried out under local anesthesia. The patient died be-cause of respiratory failure and autopsy was performed. Histopathologically cancer cells were shown in thehematoma cavity and the capsule of the hematoma was composed of two layers: a collagenous layer onthe inside and a granulation layer with neovascular system on the outside. As the neovascular system ex-isted on the outside of the capsule, the rebleeding occurred outside the capsule and the second hematomaappeared beside the initial one. We suspected that the initial bleeding occurred in the tumor tissue and therebleeding occurred in the granulation layer of the capsule.