Oka Chihiro, Miyake Yohei, Tateishi Kensuke, Kawabata Yusuke, Iwashita Hiromichi, Yamamoto Tetsuya
Department of Neurosurgery, Yokohama City University, Yokohama, Japan.
Department of Orthopedics, Yokohama City University, Yokohama, Japan.
Surg Neurol Int. 2023 Mar 3;14:80. doi: 10.25259/SNI_113_2023. eCollection 2023.
Brain metastases with hematoma are clinically important as they indicate the potential for rapid neurological deterioration. Non-uterine leiomyosarcoma-derived brain metastases are particularly rare, and their clinical features, including the bleeding rate, are unclear. Herein, we present a rare case of thigh leiomyosarcoma-derived brain metastasis with intratumoral hematoma and review previous case reports.
A 68-year-old man with a right thigh leiomyosarcoma presented with multiple brain metastases. The patient received stereotactic radiotherapy; however, he reported sudden right-sided hemiparesis. We found a right frontal irradiated lesion with intratumoral hemorrhage and performed gross total tumor resection. Histopathological examination showed highly atypical cells with prominent necrosis and hemorrhage. Abnormal thin-walled vessels were prominent within the brain tumor, and vascular endothelial growth factor was diffusely expressed immunohistopathologically. To date, 11 cases of brain metastasis from non-uterine leiomyosarcoma, including the present case, have been reported. Of note, six patients had hemorrhage. Three out of six patients presented with hemorrhage before therapeutic intervention, three cases were from residual sites after surgery or radiation.
More than half the patients with non-uterine leiomyosarcoma-derived brain metastases presented with intracerebral hemorrhage. Furthermore, these patients are at risk of developing rapid neurological deterioration due to intracerebral hemorrhage.
伴有血肿的脑转移瘤在临床上具有重要意义，因为它们提示了快速神经功能恶化的可能性。非子宫平滑肌肉瘤来源的脑转移瘤尤为罕见，其临床特征，包括出血率尚不清楚。在此，我们报告一例罕见的大腿平滑肌肉瘤来源的伴有瘤内血肿的脑转移瘤病例，并回顾既往病例报告。
一名68岁患有右大腿平滑肌肉瘤的男性出现多处脑转移。患者接受了立体定向放射治疗；然而，他报告突然出现右侧偏瘫。我们发现右侧额叶有一处接受过放疗的病灶伴有瘤内出血，并进行了肿瘤全切术。组织病理学检查显示高度异型细胞，伴有显著坏死和出血。脑肿瘤内可见异常薄壁血管，免疫组织化学检查显示血管内皮生长因子弥漫性表达。迄今为止，包括本病例在内，已报道11例非子宫平滑肌肉瘤脑转移病例。值得注意的是，6例患者出现出血。6例中有3例在治疗干预前出现出血，3例出血发生在手术或放疗后的残留部位。
超过半数的非子宫平滑肌肉瘤来源的脑转移瘤患者出现脑出血。此外，这些患者因脑出血有快速神经功能恶化的风险。
