Mochizuki Hideaki, Chikui Emiko, Tokumaru Aya, Kato Takayuki, Arai Tomio, Takahashi Hideki
Division of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Jun;49(6):472-7.
An 84-year-old man was admitted with paresis of the right lower limb. Hemorrhagic lesions were demonstrated in the left frontoparietal lobe and cerebellum by cranial computed tomography (CT) and magnetic resonance imaging (MRI). Chest CT revealed an ill-defined mass measuring 4 x 6 cm in the left lower lobe of the lung, although bronchoscopic examination failed to obtain pathological diagnosis. Clinical diagnosis of primary lung cancer with multiple brain metastases was made, and he underwent whole brain radiotherapy. The pulmonary and cerebral lesions mimicked abscesses during his clinical course, and he died of respiratory failure due to bilateral pneumonia three months after admission. Autopsy revealed that both the pulmonary and brain lesions were malignant melanomas, but no other melanoma lesions could be identified despite meticulous investigation. Although malignant melanoma with an unknown primary site is rare in Japan, careful evaluation of the CT and MRI findings might be the key to correct diagnosis in this case.
一名84岁男性因右下肢轻瘫入院。头颅计算机断层扫描（CT）和磁共振成像（MRI）显示左额顶叶和小脑有出血性病变。胸部CT显示左肺下叶有一个边界不清的肿块，大小为4×6 cm，尽管支气管镜检查未能获得病理诊断。临床诊断为原发性肺癌伴多发脑转移，患者接受了全脑放疗。在其临床过程中，肺部和脑部病变类似脓肿，入院三个月后因双侧肺炎呼吸衰竭死亡。尸检显示肺部和脑部病变均为恶性黑色素瘤，但尽管进行了细致检查，未发现其他黑色素瘤病变。虽然在日本原发部位不明的恶性黑色素瘤很少见，但仔细评估CT和MRI表现可能是本例正确诊断的关键。
