Sarmiento J Manuel, Wi Matt S, Piao Zhe, Stiner Eric S
UCLA David Geffen School of Medicine, Los Angeles, USA.
Surg Neurol Int. 2012;3:82. doi: 10.4103/2152-7806.99172. Epub 2012 Jul 28.
Brain metastases are the most common adult brain tumors, frequently arising from primary tumors in the lung, breast, skin, kidneys, and colon. Transitional cell carcinoma (TCC), the most common type of urinary bladder cancer, is a rare cause of brain metastasis with an ominous prognosis.
A 68-year-old female presented with right-sided paresis and focal motor seizures of her right upper and lower extremities 14 years after being diagnosed and treated for primary TCC of the urinary bladder with gemcitabine-based chemotherapy. MRI imaging revealed a 3.1 × 3.1 × 2.7 cm heterogeneously enhancing mass located along the posterior aspect of the left frontal convexity. The lesion was accessed using a transsulcal approach and was surgically debulked along the motor cortex with motor strip mapping, followed by adjuvant whole-brain radiation therapy. Pathological examination confirmed metastatic carcinoma with features of TCC, a rare entity among metastatic brain tumors.
Brain metastases may present several years later in patients with TCC of the urinary bladder who have been treated with surgery and chemotherapy. Chemotherapeutic agents that penetrate the blood-brain barrier, such as gemcitabine, may delay development of cerebral metastasis from primary TCC of the urinary bladder.
脑转移瘤是最常见的成人脑肿瘤，常源于肺、乳腺、皮肤、肾和结肠的原发性肿瘤。移行细胞癌（TCC）是膀胱癌最常见的类型，是脑转移的罕见原因，预后不佳。
一名68岁女性在接受基于吉西他滨的化疗治疗原发性膀胱TCC 14年后，出现右侧肢体轻瘫以及右上肢和下肢的局灶性运动性癫痫发作。MRI成像显示在左额叶凸面后部有一个3.1×3.1×2.7 cm的不均匀强化肿块。采用经沟入路进入病变，并沿运动皮层进行运动带定位手术切除大部分肿瘤，随后进行辅助全脑放射治疗。病理检查证实为具有TCC特征的转移性癌，这在转移性脑肿瘤中是一种罕见的实体。
接受过手术和化疗的膀胱TCC患者可能在数年后出现脑转移。能够穿透血脑屏障的化疗药物，如吉西他滨，可能会延迟原发性膀胱TCC脑转移的发生。
