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肺肉瘤样癌松果体转移病例中出现的复视，治疗难治。

Diplopia Presenting in a Case of Pineal Metastasis of Pulmonary Sarcomatoid Carcinoma Refractory to Treatment.

作者信息

Mitsumasa Akiyama, Shinya Nagahisa, Motoki Oeda, Hirotaka Kougame, Tadashi Kumai

机构信息

Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan.

出版信息

Asian J Neurosurg. 2020 Apr 4;15(2):449-454. doi: 10.4103/ajns.AJNS_60_20. eCollection 2020 Apr-Jun.

DOI:10.4103/ajns.AJNS_60_20
PMID:32656152
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7335143/
Abstract

A 42-year-old male presented with diplopia, headache, and nausea. Magnetic resonance imaging (MRI) of the brain showed pineal tumor, and chest computed tomography (CT) demonstrated a lung tumor. Disorientation developed, with occurrence of hydrocephalus, and we performed neuroendoscopic surgery for biopsy of the pineal tumor and third ventriculostomy. The lung tumor was biopsied under bronchoscopic and CT guidance, and based on the pathological results, we diagnosed pineal metastasis of pulmonary sarcomatoid carcinoma (cT3N1M1b Stage IVA). Stereotactic radiotherapy for the metastatic pineal tumor and systemic chemotherapy (carboplatin + pemetrexed) were pursued, but hemorrhage of the tumor occurred, hydrocephalus worsened, and neoplastic meningitis was diagnosed by MRI. Therapy was switched to nivolumab, but without effect, and the patient succumbed. Even among lung tumors, sarcomatoid carcinoma is rare. There are also few reports of lung tumors metastasized to the pineal gland. Our case report of pineal tumor regarded as metastasis of pulmonary sarcomatoid carcinoma also includes a discussion of the literature.

摘要

一名42岁男性出现复视、头痛和恶心症状。脑部磁共振成像（MRI）显示松果体肿瘤，胸部计算机断层扫描（CT）显示肺部肿瘤。患者出现定向障碍，并伴有脑积水，我们进行了神经内镜手术，以获取松果体肿瘤活检样本并进行第三脑室造瘘术。在支气管镜和CT引导下对肺部肿瘤进行了活检，根据病理结果，我们诊断为肺肉瘤样癌的松果体转移（cT3N1M1b ⅣA期）。对转移性松果体肿瘤进行了立体定向放射治疗，并进行了全身化疗（卡铂+培美曲塞），但肿瘤发生出血，脑积水加重，MRI诊断为肿瘤性脑膜炎。治疗改为使用纳武单抗，但无效，患者最终死亡。即使在肺部肿瘤中，肉瘤样癌也很罕见。关于肺部肿瘤转移至松果体的报道也很少。我们这例被视为肺肉瘤样癌转移的松果体肿瘤病例报告还包括了文献讨论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/d9406f0dcf6c/AJNS-15-449-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/9b8d77e19919/AJNS-15-449-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/2f06af245f7e/AJNS-15-449-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/c61fff048fc7/AJNS-15-449-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/dd5683bbb6d1/AJNS-15-449-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/88e1e3f0a5a1/AJNS-15-449-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/0186f75b4ca6/AJNS-15-449-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/8adbdeb55e4f/AJNS-15-449-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/f1618bd81963/AJNS-15-449-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/43cca592f758/AJNS-15-449-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/d9406f0dcf6c/AJNS-15-449-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/9b8d77e19919/AJNS-15-449-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/3427f012ac16/AJNS-15-449-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/2f06af245f7e/AJNS-15-449-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/c61fff048fc7/AJNS-15-449-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/dd5683bbb6d1/AJNS-15-449-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/88e1e3f0a5a1/AJNS-15-449-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/0186f75b4ca6/AJNS-15-449-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/8adbdeb55e4f/AJNS-15-449-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/f1618bd81963/AJNS-15-449-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/43cca592f758/AJNS-15-449-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987a/7335143/d9406f0dcf6c/AJNS-15-449-g011.jpg

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Most common sites on MRI of intracranial neoplastic leptomeningeal disease.颅内肿瘤性软脑膜疾病 MRI 最常见的部位。
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