Lim Kok Haw Jonathan, Valle Juan W, Lamarca Angela
Department of Medical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK.
Department of Medicine, Imperial College London, London, UK.
J Med Case Rep. 2019 Aug 30;13(1):273. doi: 10.1186/s13256-019-2214-5.
With increasing treatment options available, neuroendocrine tumor has become a chronic disease and may present later on with atypical manifestation of disease spread once resistant to treatment.
A 74-year-old white British woman undergoing treatment for metastatic well-differentiated neuroendocrine tumor for the past 9 years presented with a brief history of mild frontal headache, and progressive left ptosis and ocular palsy. She had no visual loss, and had neither speech nor motor deficit. At the outset, it was crucial to exclude acute or missed stroke. An urgent magnetic resonance imaging of her head revealed an unusual skull base metastasis extending into the cavernous sinus, with no peritumoral edema. Following discussion at a specialist neuro-oncology meeting and a neuroendocrine tumor multidisciplinary team meeting, she proceeded to have conventional fractionated radiotherapy followed by subsequent palliative chemotherapy.
Intracranial metastasis is rare in patients with neuroendocrine tumor, particularly in those with well-differentiated histology; skull base metastasis is even more uncommon. Management of intracranial metastasis from a rare tumor should always be discussed in a specialist multidisciplinary meeting. Surgery or radiotherapy, including stereotactic radiosurgery, should be considered in skull base metastases. Hormonal abnormalities may occur following radiotherapy to skull base metastases and should be monitored closely in the first few months post treatment.
随着可用治疗方案的增加，神经内分泌肿瘤已成为一种慢性病，一旦对治疗产生耐药性，可能会在后期出现疾病扩散的非典型表现。
一名74岁的英国白人女性，过去9年一直在接受转移性高分化神经内分泌肿瘤的治疗，出现轻度前额头痛病史短暂，以及进行性左侧上睑下垂和眼肌麻痹。她没有视力丧失，也没有言语或运动障碍。一开始，排除急性或漏诊的中风至关重要。她头部的紧急磁共振成像显示，有一个不寻常的颅底转移瘤延伸至海绵窦，周围无肿瘤周围水肿。在一次专业神经肿瘤学会议和一次神经内分泌肿瘤多学科团队会议上进行讨论后，她接受了常规分割放疗，随后进行了姑息化疗。
神经内分泌肿瘤患者发生颅内转移很少见，尤其是组织学高分化的患者；颅底转移更为罕见。罕见肿瘤颅内转移的管理应始终在专业多学科会议上进行讨论。颅底转移瘤应考虑手术或放疗，包括立体定向放射外科治疗。颅底转移瘤放疗后可能会出现激素异常，治疗后的头几个月应密切监测。
