Akasaki Yasutoshi, Tsutsumi Satoshi, Hashizume Akane, Yoshida Kohei, Sugiyama Natsuki, Ueno Hideaki, Ishii Hisato
Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
Department of Pathology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
Radiol Case Rep. 2023 Jan 31;18(4):1397-1402. doi: 10.1016/j.radcr.2023.01.022. eCollection 2023 Apr.
A 78-year-old woman presented after a fall and injury in the left forehead. She had undergone surgery for papillary thyroid carcinoma 14 years prior and breast carcinoma 7 years prior. The patient had exhibited uneventful postoperative courses without relapse or metastasis. Anticoagulants or antiplatelet agents were not prescribed her. At presentation, the patient exhibited no focal neurological deficits. Computed tomography revealed a 19 × 20 mm hemorrhagic lesion in the right temporal lobe. On cerebral magnetic resonance imaging, the center of the lesion exhibited inhomogeneous intensity on both T1- and T2-weighted sequences with heterogeneous enhancement. In contrast, the perilesional hemorrhagic regions, appearing hyperintense on both T1- and T2-weighted sequences, showed temporary regression followed by marked enlargement over the subsequent 123 days. The patient underwent total tumor resection. The microscopic findings of the resected specimens were consistent with papillary thyroid carcinoma. Minor head injuries may trigger intratumoral hemorrhage in metastatic brain tumors. Metastasis should be assumed when patients with a history of thyroid carcinoma present with a solitary parenchymal lesion with the appearance of cerebral cavernous malformation, even if they have been disease free for a long period.
一名78岁女性在左前额摔倒受伤后前来就诊。她14年前曾接受过甲状腺乳头状癌手术，7年前接受过乳腺癌手术。患者术后病程平稳，无复发或转移。未给她开抗凝剂或抗血小板药物。就诊时，患者无局灶性神经功能缺损。计算机断层扫描显示右侧颞叶有一个19×20毫米的出血性病变。在脑磁共振成像上，病变中心在T1加权和T2加权序列上均表现为不均匀信号强度，有不均匀强化。相比之下，病变周围的出血区域在T1加权和T2加权序列上均呈高信号，在随后的123天内先出现暂时消退，然后显著扩大。患者接受了肿瘤全切术。切除标本的显微镜检查结果与甲状腺乳头状癌一致。轻微头部损伤可能引发转移性脑肿瘤的瘤内出血。有甲状腺癌病史的患者出现具有脑海绵状血管瘤表现的孤立实质性病变时，即使他们已长期无病，也应考虑转移的可能。
