Yamada Kazumichi, Miura Masaki, Miyayama Haruhiko, Sakashita Naomi, Kochi Masato, Ushio Yukitaka
Department of Neurosurgery, Kumamoto University Medical School, Kumamoto City Hospital, Japan.
Surg Neurol. 2002 Nov;58(5):332-6; discussion 336-7. doi: 10.1016/s0090-3019(02)00805-4.
Brain metastasis from pancreatic cancer is extremely rare. Because pancreatic cancer usually has a rapidly progressive nature, the majority of affected patients die from primary lesions before exhibiting clinical signs suggestive of brain metastases.
The patient was a 62-year-old man who developed generalized convulsion followed by right hemiparesis accompanied by decreased consciousness level. Computed tomography (CT) scan revealed multiple brain tumors with ring-like contrast enhancement. Stereotactic biopsy disclosed mucinous adenocarcinoma. A marked increase in the serum CA19-9 level was noted, but the patient did not exhibit any other signs of pancreatic disease. Repeated whole body CT scan and ultrasonography demonstrated no primary lesions. The patient died of multi-organ failure during chemotherapy combined with radiation for metastatic brain tumors. Autopsy revealed well-differentiated papillary adenocarcinoma in the pancreatic head and systemic metastases associated with tumor emboli were widely distributed in various organs.
This patient initially presented only with symptoms of neurologic disorder and no pancreatic symptoms. Moreover, repeated radiologic examinations did not reveal the primary lesion. We considered that the unusual clinical course in our patient may be partly explained by the autopsy findings: diffuse sclerotic changes of the pancreas without swelling. The present report suggests that undetected pancreatic cancer may have been the primary lesion classified as "unknown origin" in some cases of metastatic brain tumors.
胰腺癌脑转移极为罕见。由于胰腺癌通常具有快速进展的特性，大多数受影响的患者在出现提示脑转移的临床症状之前就死于原发性病变。
该患者为一名62岁男性，出现全身性惊厥，随后出现右侧偏瘫并伴有意识水平下降。计算机断层扫描（CT）显示多个脑肿瘤，呈环状对比增强。立体定向活检显示为黏液腺癌。血清CA19-9水平显著升高，但患者未表现出任何其他胰腺疾病迹象。反复的全身CT扫描和超声检查均未发现原发性病变。患者在接受转移性脑肿瘤化疗联合放疗期间死于多器官功能衰竭。尸检显示胰头部为高分化乳头状腺癌，与肿瘤栓子相关的全身转移广泛分布于各个器官。
该患者最初仅表现出神经系统症状，无胰腺症状。此外，反复的影像学检查未发现原发性病变。我们认为，患者不寻常的临床病程可能部分由尸检结果解释：胰腺弥漫性硬化改变但无肿胀。本报告表明，在某些脑转移瘤病例中，未被发现的胰腺癌可能是被归类为“来源不明”的原发性病变。
