Spontaneous Intracranial Tumor Bleeding from Metastatic Hepatocellular Carcinoma: A Case of Report

病例報告：顱內轉移性肝癌產生自發性腫瘤出血

周文其(Wen-Chi Chou) ； 榮世明(Shih-Ming Jung) ； 陳仁熙(Jen-Shi Chen)

《中華民國癌症醫學會雜誌》 21卷2期 (2005/06) Pp. 34-39

https://doi.org/10.6588/JCOS.2005.21.2.2

摘要

肝癌為臺灣常見之惡性腫瘤，大多數腫瘤在診斷初期仍侷限在肝臟內部，以局部侵犯所造成的臨床症狀為主要表現。肝癌的遠處轉移通常以局部淋巴結、肺臟及骨骼為主。顱內轉移並不常見，但此類病患常常以顱內出血為初始臨床表現，常見症狀包括突發性意識變化、半身偏癱或急性頭痛。腦部電腦斷層於未顯影相與一般自發性腦血管出血的影像類似，但出血病兆周圍伴有明顯的腦組織水腫為其特色，於顯影後，顱內腫瘤會有明顯顯影，表示此類腫瘤富含血管。肝癌顱內轉移容易出血可能與腫瘤本身富含血管及病患本身原本肝硬化導致的凝血功能不良有關。肝癌發生腦部轉移可能透過血行性轉移，因為此類病患先前多數已診斷有肺部轉移。此類病患預後非常不佳，即使接受腦部放射線治療或手術切除顱內腫瘤，病患大多死於顱內壓過高導致的腦幹壓迫或腫瘤全身侵犯導致之器官衰竭。本篇病例報告乙例典型肝癌患者併發顱內轉移的臨床病程及處置經過，同時回顧以往前人發表的相關文獻報告。

並列摘要

The most common metastatic sites of hepatocellular carcinoma (HCC) include intra-abdominal lymph nodes, lung and bones. Extremely rare cases present as intracranial metastases, which almost have precluded pulmonary metastases. Due to the tendency of spontaneous tumor bleeding, these patients frequently presented with symptoms and signs which were similar to the presentations of intracranial hemorrhage, such as sudden onset consciousness change, hemiplegia, and headache.
We report a typical case of HCC with pulmonary metastases followed by intracranial metastasis with spontaneous tumor bleeding, and review the literature.

並列關鍵字

Hepatocellular carcinoma ； brain metastasis ； intracranial hemorrhage