Early Intracranial Metastases from a Huge Malignant Pleural Mesothelioma-A Case Report

一巨大惡性肋膜間皮瘤併早期腦轉移：一病例報告

楊崇德(Chung-De Yang) ； 朱國安(Kuo-An Chu) ； 蕭惠元(Hui-Yuan Hsiao) ； 林旻希(Min-Hsi Lin) ； 曾暉華(Hui-Hwa Tseng) ； 賴瑞生(Ruay-Sheng Lai)

《胸腔醫學》 28卷5期 (2013/10) Pp. 309-314

摘要

惡性肋膜間皮瘤是一個罕見且高致死率的疾病。我們報告一位病例以右後側肋膜腔15公分的腫瘤為表現。經由超音波導引腫瘤病理切片，診斷為上皮性的惡性間皮瘤。系統性影像檢查並沒有發現任何遠端轉移。在接受兩個療程的化學治療後，病患出現了明顯的中樞神經症狀。經由腦部核磁共振，診斷了雙側小腦的腫瘤轉移。病患接受了腦部的放射治療但是沒有反應。他在診斷後三個月死亡。惡性間皮瘤在傳統上被認為總是造成腫瘤局部侵犯，而較少有遠端血行性轉移的現象。早期且有症狀的腦部轉移在罹患惡性肋膜間皮瘤的病患中是非常少見的情形，而且也是相當罕見造成死亡的原因。

關鍵字

間皮瘤 ； 肋膜 ； 上皮性 ； 腦部轉移

並列摘要

Malignant pleural mesothelioma is a rare disease and is associated with high mortality. We reported the case of a patient initially presenting with a 15 cm mass in the right posterior pleural space. Pathologic diagnosis of malignant mesothelioma, epithelioid subtype, was made by means of sonography-guided tumor biopsy. No distant metastasis was found in the initial systemic image survey. After receiving 2 courses of chemotherapy, the patient developed significant central nervous system symptoms. The diagnosis of bilateral cerebellar metastases was established by brain magnetic resonance image. The patient underwent brain radiation therapy, but with no response, and died 3 months after the initial diagnosis. Malignant pleural mesothelioma is traditionally regarded as a tumor that occurs through aggressive local invasion rather than distant hematogenous spread. Early and symptomatic brain metastases are a rare event in patients with malignant pleural mesothelioma and a very rare cause of death, as in our case.

並列關鍵字

mesothelioma ； pleural ； epithelioid ； brain metastases