Goto Akira, Ishimine Yu, Hirata Tsubasa, Naito Takafumi, Yabana Takashi, Adachi Takeya, Kondo Yoshihiro, Kasai Kiyoshi
Dept. of Gastroenterology,Otaru General Hospital.
Gan To Kagaku Ryoho. 2014 Oct;41(10):1245-9.
We present a rare case of colorectal carcinoma in which hemiparesis was the initial symptom. A 75-year-old woman presented with incomplete left-sided hemiparesis. Brain magnetic resonance imaging(MRI)revealed a 13-mm mass in the right frontal lobe; the mass was resected via craniotomy. Pathological findings, which included the results of immunohistochemical analysis, indicated brain metastasis from colorectal cancer. Colonoscopy revealed advanced colon cancer in the ascending colon, and computed tomography(CT)did not reveal any extracranial metastases. Left-sided hemicolectomy was performed. Whole-brain radiotherapy was scheduled, but before initiation of the therapy, metastases were detected in the neck lymph node and right arm skin, and the brain metastases relapsed. The relapsed brain metastatic lesions were resected, and radiotherapy was administered to the whole brain and the severely painful site of skin metastasis. However, the patient died 201 days after presentation. Historically, systemic chemotherapy was considered ineffective for metastatic brain tumor, and the standard treatments for brain metastasis were surgery and radiotherapy. Although recent advances in systemic chemotherapy for colorectal cancer have resulted in improved patient survival, patients with brain metastases from colorectal cancer still have a poor prognosis. Modern chemotherapeutic agents, including molecularly targeted agents such as bevacizumab, should be validated for the management of brain metastases.
我们报告一例罕见的以偏瘫为首发症状的结直肠癌病例。一名75岁女性出现左侧不完全偏瘫。脑部磁共振成像（MRI）显示右额叶有一个13毫米的肿块；通过开颅手术切除了该肿块。病理检查结果，包括免疫组化分析结果，提示为结直肠癌脑转移。结肠镜检查发现升结肠有进展期结肠癌，计算机断层扫描（CT）未发现任何颅外转移。遂行左侧半结肠切除术。计划进行全脑放疗，但在开始治疗前，颈部淋巴结和右臂皮肤发现转移，脑转移复发。对复发的脑转移病灶进行了切除，并对全脑和皮肤转移的剧痛部位进行了放疗。然而，患者在就诊后201天死亡。从历史上看，全身化疗被认为对转移性脑肿瘤无效，脑转移的标准治疗方法是手术和放疗。尽管近年来结直肠癌全身化疗取得进展，患者生存率有所提高，但结直肠癌脑转移患者的预后仍然很差。包括贝伐单抗等分子靶向药物在内的现代化疗药物，应验证其对脑转移的治疗效果。
