Subdural Metastatic Adenocarcinoma Mimicking Chronic Subdural Hematoma in Image Features and Clinical Presentation

我們報告一個硬腦膜下腔轉移性腺癌的病例，其臨床表現和影像檢查近似於慢性硬腦膜下血腫。儘管已知病人罹患全身性轉移腺癌，最初的診斷和治療仍是針對慢性硬腦膜下血腫。在顱骨鑽孔手術當中我們發現病人的硬腦膜下腔充滿了固體腫瘤而非慢性血腫，病理檢查確定其為轉移腺癌。病人後續接受了全腦放射治療，並於術後三個月死亡。類似的病例在文獻之中很少被報告。顯影之後的腦部斷層掃描及磁振造影是良好的鑑別診斷工具。另一方面，慢性硬腦膜下血腫也可能是癌病移轉移至硬腦膜的結果或是癌症轉移的目標。我們認為若病患有癌症病史，癌症轉移須列為硬腦膜下病灶的鑑別診斷之一，而腦部電腦斷層或磁振造影檢查宜加入顯影劑，且在為癌症病人進行慢性硬腦膜下血腫的手術時，須採取硬腦膜及慢性血腫外膜的檢體以便病理檢查。

關鍵字

硬腦膜下轉移；硬腦膜下血腫；顱內轉移；硬腦膜轉移

並列摘要

We report a case of subdural metastasis in which the clinical features and associated images mimic chronic subdural hematoma. Despite a known history of systemic metastasis of adenocarcinoma, the initial diagnosis and treatment were directed toward chronic subdural hematoma. During burr-hole operation, the subdural space was found to be filled will solid tumor rather than chronic hematoma. Pathology examination confirmed metastatic adenocarcinoma. The patient received subsequent whole brain irradiation and died 3 months after operation. Similar situations have rarely been reported in the literature. CT and MRI with enhancement can be adequate tools for differential diagnosis. On the other hand, chronic subdural hematoma may be a presentation of dural metastasis or a target of metastasis. We conclude that if a patient has history of cancer, subdural metastasis should be considered and brain CT or MRI be performed with contrast enhancement when making differential diagnosis of subdural collection. Furthermore, dural and outer membrane specimens should be taken during operation for chronic subdural hematoma in patients with malignancy.

並列關鍵字

subdural metastasis ； subdural hematoma ； intracranial metastasis ； dural metastasis

國際替代計量

Subdural Metastatic Adenocarcinoma Mimicking Chronic Subdural Hematoma in Image Features and Clinical Presentation

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