Kazumoto K, Hayase N, Kurosumi M, Kishi K, Uki J, Takeda F
Neurosurgery Clinic, Saitama Cancer Center, Ina, Japan.
Surg Neurol. 1998 Nov;50(5):475-9. doi: 10.1016/s0090-3019(97)00341-8.
Adenoid cystic carcinoma is a slow-growing malignant tumor occurring in the head and neck. Intracranial involvement usually results from direct skull invasion from adjacent primary sites. To our knowledge, this is the first reported case of multiple brain parenchymal metastases manifesting with hemorrhage.
A 60-year-old male experienced sudden onset of hemiparesis caused by an intracerebral hematoma in a brain metastasis from adenoid cystic carcinoma. The primary parotid tumor was treated 15 months before the appearance of the brain metastases. The hemorrhagic metastasis was resected, and cranial irradiation was performed. The brain metastasis had increased cellular atypism compared with the primary tumor. The patient remained well and free of neurologic dysfunctions until 5 months after the radiotherapy was completed; he died of systemically advanced disease 8 months after the craniotomy.
Hematogeneous brain metastases of adenoid cystic carcinoma are quite rare and cannot be distinguished from those of other cancers radiologically. We assume that the intratumoral hemorrhage is related to the tendency of the tumor to spread around the vessels. Although radiation therapy is not curative, it is beneficial in controlling tumor regrowth.
腺样囊性癌是一种发生于头颈部的生长缓慢的恶性肿瘤。颅内受累通常是由于邻近原发部位直接侵犯颅骨所致。据我们所知，这是首例报道的以出血为表现的多发脑实质转移瘤病例。
一名60岁男性因腺样囊性癌脑转移灶内的脑内血肿突然出现偏瘫。在脑转移灶出现前15个月对原发腮腺肿瘤进行了治疗。对出血性转移瘤进行了切除，并进行了颅脑照射。与原发肿瘤相比，脑转移瘤的细胞异型性增加。患者在放疗完成后5个月内情况良好，无神经功能障碍；开颅术后8个月死于全身进展性疾病。
腺样囊性癌的血行性脑转移非常罕见，在影像学上无法与其他癌症的脑转移相鉴别。我们推测肿瘤内出血与肿瘤围绕血管扩散的倾向有关。尽管放射治疗不能治愈，但有助于控制肿瘤再生。
