多発性に脳出血を繰り返した転移性脳腫瘍の1例

A Case of Metastatic Brain Tumor Complicated by Multiple Repeated Hemorrhages

Ⅰ．はじめに

　転移性脳腫瘍は稀に脳出血で発症することがある^2,3)．今回われわれは，多発性に脳出血を繰り返して緩徐に血腫が増大した症例を経験した．開頭術を施行し，転移性脳腫瘍の病理診断をもとに放射線治療を施行した．症例を提示し，転移性脳腫瘍からの多発性の出血や血腫の増大について文献的考察を加える．

　Metastatic brain tumor occasionally results in multiple cerebral hemorrhages. Here, we report a case of metastatic brain tumor complicated by multiple repeated cerebral hemorrhages. An 80-year-old man with a history of removal of lung cancer was admitted to our hospital because of disturbed consciousness following headache. A brain CT revealed a mass lesion of 40-mm diameter in the left cerebellum and a mass lesion of 2-mm diameter in the right temporal lobe. The cerebellar mass lesion showed homogeneous iso-density, indicating a subacute phase hemorrhage. Two days later, a follow-up CT revealed that the mass lesion had become high-density, indicating complication by a fresh hemorrhage. Hematoma was removed and histological examination was performed on the cerebellar lesion. There was leakage of dark-red liquid intraoperatively, and histological examination revealed an adenocarcinoma, indicating metastasis of the lung cancer. Additionally, necrosis and hemorrhage were identified. Postoperatively, whole brain irradiation was performed. The right temporal lesion gradually enlarged but disappeared after irradiation. In conclusion, multiple brain metastases may result in multiple cerebral hemorrhages. Repeated hemorrhage from necrosis of the carcinoma causes a slowly growing hematoma.