Ogawa Masaya, Kurahashi Kozo, Ebina Akio, Kaimori Mitsuomi, Wakabayashi Koichi
Department of Neurology, Aomori Prefectural Central Hospital, Aomori,mJapan.
Neuropathology. 2007 Aug;27(4):390-5. doi: 10.1111/j.1440-1789.2007.00782.x.
We report an autopsy case of an 82-year-old woman with progressive dementia due to miliary brain metastasis from lung adenocarcinoma. The patient presented with dementia 5 months prior to death and suddenly died of pulmonary hemorrhage. Postmortem examination revealed normal appearance of the brain. However, there were numerous foci of cancer metastasis in all parts of the brain on light microscopic examination. The carcinoma cells were located in the perivascular (Virchow-Robin) space and did not invade to the brain parenchyma. The carcinoma cells were also found in the subpial space. In the cerebral cortex, foci of metastasis appeared to spread in the following way: tiny foci of metastasis initially occur in the middle cortical layer, then spread to all layers through the perivascular space, and finally reach the subpial space and subcortical white matter. Although the junction between gray and white matter is a preferred site for usual brain metastasis, middle cortical layer was considered to be the initial site for metastasis in our patient. The perivascular pial sheath plays an important role for the development of miliary brain metastasis.
我们报告一例82岁女性尸检病例，该患者因肺腺癌粟粒性脑转移导致进行性痴呆。患者在死亡前5个月出现痴呆症状，最终突然死于肺出血。尸检显示脑部外观正常。然而，在光镜检查下，脑内各部位均发现大量癌转移灶。癌细胞位于血管周围（Virchow-Robin）间隙，未侵犯脑实质。在软脑膜下间隙也发现了癌细胞。在大脑皮质，转移灶似乎以以下方式扩散：微小转移灶最初出现在皮质中层，然后通过血管周围间隙扩散到所有层，最终到达软脑膜下间隙和皮质下白质。虽然灰质和白质交界处是常见脑转移的好发部位，但在我们的患者中，皮质中层被认为是转移的起始部位。血管周围软脑膜鞘对粟粒性脑转移的发生起重要作用。
