脳室内出血を来たした腎細胞癌の脈絡叢転移の1例

Choroid Plexus Metastasis of Renal Cell Carcinoma Causing Intraventricular Hemorrhage : a case report

I．はじめに

　転移性脳腫瘍のうちで脈絡叢への孤立性転移は非常に稀である^6）．われわれは，2度に亘る脳室内出血の原因が，側脳室三角部への腎細胞癌の孤立性脈絡叢転移であることが手術により確認された症例を経験したので，文献的考察を加えて報告する．

We report a rare case of choroid plexus metastasis of renal cell carcinoma causing intraventricularhemorrhage. A 75-year-old female was admitted to our hospital for SAH Preoperative examination evokedsuspicion of an anterior communicating aneurysm as a cause of SAH. Furthermore, there were lesions onthe tuberculum sellae and in the left trigone of the lateral ventricle, which were enhanced by Gd-DTPA onMRI. The patient was operated on via the pterional approach on December 3, 1996, but no aneurysm wasfound. She underwent total removal of the tuberculum sellae mass, which was postoperatively proved to bea meningioma by histological examination. The intraventricular tumor was supposed to be a meningioma,but it was not treated surgically. Two months later, the patient presented hematuria and was diagnosed ashaving a right renal cancer and underwent right nephrectomy on March 18, 1997. However, postoperative-ly, disturbance of consciousness continued. A CT scan revealed intraventricular hemorrhage around thetumor in the trigone of the lateral ventricle on March 21. An emergency operation for tumor and clot re-moval succeeded in improving the patient's condition. Histological examination of the tumor revealed clear-cell type renal cell carcinoma.

Solitary choroidal plexus metastasis from renal cell carcinoma is quite rare : only 5 cases have been re-ported. But only our case was accompanied by intraventricular hemorrhage. Renal cell carcinomas are di-vided into two types: a slowly progressive type and a rapidly progressive type. Four cases among the re-ported 5 cases were the slowly progressive type, and our case was regarded as being of the same type.