Oyama Hirofumi, Kito Akira, Maki Hideki, Hattori Kenichi, Niwa Aichi
Department of Neurosurgery, Ogaki Municipal Hospital, Gifu, Japan.
No Shinkei Geka. 2011 Jul;39(7):663-8.
Thymoma with metastasis to the central nervous system is extremely rare. Herein, three rare cases of thymoma with intracranial metastasis are reported. Case 1 (thymoma, B3 in the WHO classification); cranial magnetic resonance imaging (MRI) revealed a mass lesion with a ring enhancement effect in the right temporal lobe. The cystic and hemorrhagic lesion was subtotally removed and radiation therapy of 40 Gy was administered to the tumor cavity containing the remains of the tumor around the ependyma. The patient received combination chemotherapy with carboplatin and gemcitabine hydrochloride, and he was discharged 3 months after the operation. Case 2 [(thymoma, C (thymic carcinoma)]; multiple cerebral metastases of 8 lesions were found and whole brain irradiation of 40 Gy was performed. Three months later, rapid development of 2 metastatic lesions resulted in the patient's death. At autopsy, neoplastic lesions were found in the neck lymph node, right shoulder, chest frame, pleural cavity, diaphragm, lung, periaortic lymph node, liver and pancreas. Case 3 (thymoma, B2); computed tomography (CT) scan and MRI showed a tumorous lesion over the cerebellar hemisphere. At operation, a vascular, elastic-soft and grey tumor was found to originate from the dura mater and had invaded the occipital bone. The tumor had also invaded the arachnoid membrane and sinus wall but the pia mater was free from invasion. Thereafter local irradiation of 40 Gy was performed to the tumor cavity containing the remains of the tumor around the sinus. However local recurrence reoccured 3 years later. After stereotactic irradiation of 40 Gy to the recurrent tumor, the tumor diminished. The patient is wheelchair-bound 3 years and 4 months after the operation. Most cerebral metastases are extremely rare. Outcome remains poor and life expectancy is very short when brain metastasis is present. Treatment for thymoma is multimodal, including surgery, irradiation and chemotherapy.
胸腺瘤转移至中枢神经系统极为罕见。本文报道了3例罕见的胸腺瘤颅内转移病例。病例1（世界卫生组织分类中的B3型胸腺瘤）；头颅磁共振成像（MRI）显示右侧颞叶有一具有环形强化效应的肿块病变。对该囊性和出血性病变进行了次全切除，并对包含肿瘤残留的肿瘤腔（位于室管膜周围）给予40 Gy的放射治疗。患者接受了卡铂和盐酸吉西他滨的联合化疗，术后3个月出院。病例2（C型胸腺瘤（胸腺癌））；发现8个病灶的多发脑转移，并进行了40 Gy的全脑照射。3个月后，2个转移病灶迅速发展导致患者死亡。尸检发现颈部淋巴结、右肩部、胸廓、胸腔、膈肌、肺、主动脉周围淋巴结、肝脏和胰腺有肿瘤性病变。病例3（B2型胸腺瘤）；计算机断层扫描（CT）和MRI显示小脑半球上方有一肿瘤性病变。手术时，发现一个血管丰富、质地柔软且呈灰色的肿瘤起源于硬脑膜并侵犯了枕骨。肿瘤还侵犯了蛛网膜和窦壁，但软脑膜未受侵犯。此后，对包含肿瘤残留的肿瘤腔（位于窦周围）给予40 Gy的局部照射。然而，3年后局部复发。对复发病灶进行40 Gy的立体定向照射后，肿瘤缩小。术后3年4个月，患者需依靠轮椅行动。大多数脑转移极为罕见。当出现脑转移时，预后仍然很差，预期寿命很短。胸腺瘤的治疗是多模式的，包括手术、放疗和化疗。
