内容紹介
Colorectal Carcinoma with Hemiparesis Due to Isolated Brain Metastases as an Initial Symptom―A Case Report
Summary
We present a rare case of colorectal carcinoma in which hemiparesis was the initial symptom. A 75-year-old woman presented with incomplete left-sided hemiparesis. Brain magnetic resonance imaging(MRI)revealed a 13-mm mass in the right frontal lobe; the mass was resected via craniotomy. Pathological findings, which included the results of immunohistochemical analysis, indicated brain metastasis from colorectal cancer. Colonoscopy revealed advanced colon cancer in the ascending colon, and computed tomography(CT)did not reveal any extracranial metastases. Left-sided hemicolectomy was performed. Whole-brain radiotherapy was scheduled, but before initiation of the therapy, metastases were detected in the neck lymph node and right arm skin, and the brain metastases relapsed. The relapsed brain metastatic lesions were resected, and radiotherapy was administered to the whole brain and the severely painful site of skin metastasis. However, the patient died 201 days after presentation. Historically, systemic chemotherapy was considered ineffective for metastatic brain tumor, and the standard treatments for brain metastasis were surgery and radiotherapy. Although recent advances in systemic chemotherapy for colorectal cancer have resulted in improved patient survival, patients with brain metastases from colorectal cancer still have a poor prognosis. Modern chemotherapeutic agents, including molecularly targeted agents such as bevacizumab, should be validated for the management of brain metastases.
要旨
左不全麻痺により発症したまれな大腸癌を報告する。患者は75歳,女性。左不全麻痺にて初診。右前頭葉に13 mmの腫瘤を認めた。開頭腫瘍摘出術を施行。病理所見は腺癌,免疫染色により大腸癌が疑われた。大腸内視鏡で上行結腸癌と診断。頭蓋外転移は認められなかった。左半結腸切除を施行。全脳照射を予定していたが,頸部リンパ節および右上腕皮膚転移,また脳転移再発を認めた。脳転移再発は再手術を行った。その後,全脳照射と疼痛の強い右上腕皮転移に放射線照射を行ったが,第201病日に永眠された。大腸癌の治療成績は化学療法の進歩により大きく改善している。しかし脳転移を有する大腸癌の予後は未だ不良である。歴史的に脳転移には化学療法は無効とされ,手術と放射線療法が行われている。しかしベバシズマブなどを含む現代の化学療法での有効性の評価も必要と思われた。
目次
Summary
We present a rare case of colorectal carcinoma in which hemiparesis was the initial symptom. A 75-year-old woman presented with incomplete left-sided hemiparesis. Brain magnetic resonance imaging(MRI)revealed a 13-mm mass in the right frontal lobe; the mass was resected via craniotomy. Pathological findings, which included the results of immunohistochemical analysis, indicated brain metastasis from colorectal cancer. Colonoscopy revealed advanced colon cancer in the ascending colon, and computed tomography(CT)did not reveal any extracranial metastases. Left-sided hemicolectomy was performed. Whole-brain radiotherapy was scheduled, but before initiation of the therapy, metastases were detected in the neck lymph node and right arm skin, and the brain metastases relapsed. The relapsed brain metastatic lesions were resected, and radiotherapy was administered to the whole brain and the severely painful site of skin metastasis. However, the patient died 201 days after presentation. Historically, systemic chemotherapy was considered ineffective for metastatic brain tumor, and the standard treatments for brain metastasis were surgery and radiotherapy. Although recent advances in systemic chemotherapy for colorectal cancer have resulted in improved patient survival, patients with brain metastases from colorectal cancer still have a poor prognosis. Modern chemotherapeutic agents, including molecularly targeted agents such as bevacizumab, should be validated for the management of brain metastases.
要旨
左不全麻痺により発症したまれな大腸癌を報告する。患者は75歳,女性。左不全麻痺にて初診。右前頭葉に13 mmの腫瘤を認めた。開頭腫瘍摘出術を施行。病理所見は腺癌,免疫染色により大腸癌が疑われた。大腸内視鏡で上行結腸癌と診断。頭蓋外転移は認められなかった。左半結腸切除を施行。全脳照射を予定していたが,頸部リンパ節および右上腕皮膚転移,また脳転移再発を認めた。脳転移再発は再手術を行った。その後,全脳照射と疼痛の強い右上腕皮転移に放射線照射を行ったが,第201病日に永眠された。大腸癌の治療成績は化学療法の進歩により大きく改善している。しかし脳転移を有する大腸癌の予後は未だ不良である。歴史的に脳転移には化学療法は無効とされ,手術と放射線療法が行われている。しかしベバシズマブなどを含む現代の化学療法での有効性の評価も必要と思われた。