Chu Christina, Navalkissoor Shaunak, Gillmore Roopinder
Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.
Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK.
BMJ Case Rep. 2015 Sep 22;2015:bcr2015210422. doi: 10.1136/bcr-2015-210422.
A 63-year-old man, a wheelchair user, from primary progressive multiple sclerosis (MS), presented with an episode of expressive dysphasia and confusion. Cerebral imaging revealed a solitary cerebral mass that was radiologically felt to be a primary brain tumour, but a brain biopsy demonstrated an adenocarcinoma in keeping with brain metastasis. Further immunohistochemistry suggested a probable colorectal primary. Subsequent staging confirmed a primary cancer within the caecum/terminal ileum, with extensive bilobar unresectable liver metastases. Unfortunately, as a consequence of the heavy tumour burden and rapid disease progression, the patient deteriorated rapidly and, due to his poor performance status, palliative chemotherapy was not deemed suitable. He was offered palliative whole brain radiotherapy to help control his symptoms, but he declined. He subsequently died at home a few weeks later, as per his wishes.
一名63岁男性，因原发性进行性多发性硬化症而需使用轮椅，出现了一次表达性失语和意识模糊发作。脑部影像学检查发现一个孤立性脑肿块，从放射学角度认为是原发性脑肿瘤，但脑活检显示为腺癌，符合脑转移瘤。进一步的免疫组化提示可能的原发部位为结肠直肠。后续分期证实盲肠/回肠末端存在原发性癌症，并伴有广泛的双侧叶不可切除肝转移。不幸的是，由于肿瘤负荷重且疾病进展迅速，患者病情迅速恶化，鉴于其身体状况差，姑息性化疗被认为不合适。曾建议对其进行姑息性全脑放疗以帮助控制症状，但他拒绝了。几周后，他按照自己的意愿在家中去世。
