RESUMEN
One of the most invasive malignant tumors of the cerebellum is medulloblastoma, which is also the most common malignant tumor of the brain in children. Patients with a recurrent disease following initial treatment have the most unfavorable prognosis. The most common metastasis locations are the spine, the posterior fossa, the bones, and the supratentorium. Late medulloblastoma metastasis in the supratentorial intraventricular region is uncommon. We report here a case with supratentorial seeding.
Asunto(s)
Humanos , Femenino , Preescolar , Neoplasias Supratentoriales/secundario , Meduloblastoma/cirugía , Meduloblastoma/patología , Metástasis de la Neoplasia , Recurrencia , Neoplasias Supratentoriales/patología , Neoplasias Supratentoriales/terapia , Meduloblastoma/diagnóstico por imagenAsunto(s)
Neoplasias de la Mama/patología , Carcinoma/cirugía , Complicaciones Intraoperatorias/diagnóstico , Metastasectomía , Procedimientos Neuroquirúrgicos , Neoplasias Supratentoriales/cirugía , Cardiomiopatía de Takotsubo/diagnóstico , Carcinoma/secundario , Resultado Fatal , Femenino , Humanos , Complicaciones Intraoperatorias/fisiopatología , Complicaciones Intraoperatorias/terapia , Persona de Mediana Edad , Choque Cardiogénico/fisiopatología , Choque Cardiogénico/terapia , Neoplasias Supratentoriales/secundario , Cardiomiopatía de Takotsubo/fisiopatología , Cardiomiopatía de Takotsubo/terapiaRESUMEN
BACKGROUND: Perfusion computed tomography (PCT) reflects blood flow and capillary condition, which is valuable in assessing brain tumors. We evaluated PCT parameters at the tumor (t) and peritumoral (p) region to differentiate malignant brain tumors. METHODS: We performed PCT in 39 patients with supratentorial malignant brain tumors (22 glioblastomas, 6 lymphomas, 11 metastases). Regions of interests were placed manually at tumor, peritumoral region, and contralateral normal-appearing white matter. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability surface (PS) were measured. These parameters were divided by those of contralateral normal-appearing white matter to normalize at tumor (relative [r]CBVt, rCBFt, rMTTt, rPSt) and peritumoral regions (rCBVp, rCBFp, rMTTp, rPSp). The parameters were evaluated with Mann-Whitney U test and receiver operating characteristics analyses. Stepwise analyses also were performed to select useful PCT parameters for differentiating these tumors. RESULTS: The rCBFt and rCBVt of glioblastoma (GBM) were greater than those of primary central nervous system lymphoma (PCNSL) (P = 0.0005, 0.0002) and brain metastasis (METS) (P = 0.0044, 0.0028). The rMTTp of METS was greater than that of GBM and PCNSL (P = 0.0001, 0.0007). The combination of rCBVt and rPSt could differentiate GBM from other tumors with sensitivity and specificity of 81.8% and 94.1%. The combination of rCBFp and rMTTp could differentiate METS from other tumors with sensitivity and specificity of 90.9% and 82.1%. CONCLUSIONS: Our study introduces and supports the usefulness of PCT parameters for differentiation among GBM, PCNSL, and METS. rCBVt and rPSt may be the best predictors of GBM. rCBFp and rMTTp may be the best predictors of METS.
Asunto(s)
Glioblastoma/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Neoplasias Supratentoriales/diagnóstico por imagen , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Neoplasias Supratentoriales/secundario , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Cerebral metastasis (CM) is the most common malignancy affecting the brain. In patients eligible for surgery, complete tumor removal is the most important predictor of overall survival and neurological outcome. The emergence of surgical microscopes fitted with a fluorescein-specific filter have facilitated fluorescein-guided microsurgery and identification of tumor tissue. In 2012, we started evaluating fluorescein (FL) with the dedicated microscope filter in cerebral metastases (CM). After describing the treatment results of our first 30 patients, we now retrospectively report on 95 patients. METHODS: Ninety-five patients with CM of different primary cancers were included (47 women, 48 men, mean age, 60 years, range, 25-85 years); 5 mg/kg bodyweight of FL was intravenously injected at induction of anesthesia. A YELLOW 560-nm filter (Pentero 900, ZEISS Meditec, Germany) was used for microsurgical tumor resection and resection control. The extent of resection (EOR) was assessed by means of early postoperative contrast-enhanced MRI and the grade of fluorescent staining as described in the surgical reports. Furthermore, we evaluated information on neurological outcome and surgical complications as well as any adverse events. RESULTS: Ninety patients (95%) showed bright fluorescent staining that markedly enhanced tumor visibility. Five patients (5%); three with adenocarcinoma of the lung, one with melanoma of the skin, and one with renal cell carcinoma) showed insufficient FL staining. Thirteen patients (14%) showed residual tumor tissue on the postoperative MRI. Additionally, the MRI of three patients did not confirm complete resection beyond doubt. Thus, gross-total resection had been achieved in 83% (n = 79) of patients. No adverse events were registered during the postoperative course. CONCLUSIONS: FL and the YELLOW 560-nm filter are safe and feasible tools for increasing the EOR in patients with CM. Further prospective evaluation of the FL-guided technique in CM-surgery is in planning.
Asunto(s)
Fluoresceína , Colorantes Fluorescentes , Imagen por Resonancia Magnética/métodos , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Neoplasias Supratentoriales/cirugía , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/patología , Femenino , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Neoplasia Residual , Procedimientos Neuroquirúrgicos/efectos adversos , Neoplasias Supratentoriales/diagnóstico por imagen , Neoplasias Supratentoriales/secundarioRESUMEN
BACKGROUND: Brain metastasis of lung cancer adversely affects overall survival (OS) and quality of life, while peritumoral brain edema is responsible for life-threatening complications. METHODS: We retrospectively analyzed the clinicopathological and cerebral radiological data of 575 consecutive lung cancer patients with brain metastases. RESULTS: In adenocarcinoma and squamous cell carcinoma, peritumoral brain edema was more pronounced than in small-cell lung cancer (p < 0.001 and p < 0.001, respectively). There was a positive correlation between the size of metastasis and the thickness of peritumoral brain edema (p < 0.001). It was thicker in supratentorial tumors (p = 0.019), in younger patients (≤50 years) (p = 0.042), and in females (p = 0.016). The time to development of brain metastasis was shorter in central than in peripheral lung cancer (5.3 vs. 9.0 months, p = 0.035). Early brain metastasis was characteristic for adenocarcinomas. A total of 135 patients had brain only metastases (N0 disease) characterized by peripheral lung cancer predominance (p < 0.001) and a longer time to development of brain metastasis (9.2 vs. 4.4 months, p < 0.001). OS was longer in the brain only subgroup than in patients with N1-3 diseases (p < 0.001). CONCLUSIONS: The clinicopathological characteristics of lung cancer are related to the development and radiographic features of brain metastases. Our results might be helpful in selecting patients who might benefit from prophylactic cranial irradiation.
Asunto(s)
Adenocarcinoma/secundario , Edema Encefálico/etiología , Carcinoma de Células Escamosas/secundario , Neoplasias Infratentoriales/secundario , Neoplasias Pulmonares/patología , Pulmón/patología , Neoplasias Supratentoriales/secundario , Anciano , Femenino , Humanos , Neoplasias Infratentoriales/complicaciones , Neoplasias Infratentoriales/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Supratentoriales/complicaciones , Neoplasias Supratentoriales/patología , Tasa de Supervivencia , Factores de Tiempo , Carga TumoralRESUMEN
OBJECTIVE: A positive correlation between serum B-type natriuretic peptide levels and the amount of dislodgement of intracranial structures (mass effect) produced by brain tumors has been demonstrated previously. The aim of our prospective observational study was to evaluate a possible relationship between serum B-type natriuretic peptide levels and the amount of neoplastic edema in patients affected by brain tumor. METHODS: We prospectively studied 110 patients with a supratentorial brain tumor. Serum N-terminal-pro B-type natriuretic peptide was measured and brain magnetic resonance images were analyzed to discriminate between neoplastic tissue and perilesional edema. A multivariate linear regression model predictive for serum N-terminal-pro B-type natriuretic peptide levels was generated. RESULTS: The radiologic diagnoses were meningioma in 45 patients (40.9%), glioma in 33 (30%), and metastasis in 32 (29.1%). A mass effect was present in 29 (26.4%) patients. Serum N-terminal-pro B-type natriuretic peptide was 125.61 ± 174.14 pg/mL (median 60 pg/mL, interquartile range 28-139 pg/mL). Four variables were entered into a multivariate linear regression model predictive for serum N-terminal-pro B-type natriuretic peptide values: age, neoplastic edema volume, metastatic lesion, and the presence of a mass effect (whole model P < 0.0001; R(2) = 0.5555; adjusted R(2) = 0.5294). CONCLUSIONS: Our data demonstrate that serum B-type natriuretic peptide levels are positively correlated to neoplastic brain edema in patients with a brain tumor and suggest a possible cerebral source for this phenomenon.
Asunto(s)
Edema Encefálico/diagnóstico , Edema Encefálico/fisiopatología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Neoplasias Supratentoriales/diagnóstico , Neoplasias Supratentoriales/fisiopatología , Adulto , Anciano , Femenino , Glioma/diagnóstico , Glioma/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/fisiopatología , Meningioma/diagnóstico , Meningioma/fisiopatología , Persona de Mediana Edad , Análisis Multivariante , Estudios Prospectivos , Valores de Referencia , Estadística como Asunto , Neoplasias Supratentoriales/secundarioRESUMEN
BACKGROUND: Primary central nervous system lymphomas (PCNSL) constitute a rare group of extranodal non-Hodgkin's lymphomas (NHLs). AIM: To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. MATERIALS AND METHODS: This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. INCLUSION CRITERIA: Cases of PCNSL involving brain. EXCLUSION CRITERIA: Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. RESULTS: There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%). CONCLUSION: DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.
Asunto(s)
Inmunocompetencia , Linfoma no Hodgkin/diagnóstico , Neoplasias Supratentoriales/diagnóstico , Adolescente , Adulto , Anciano , Niño , Femenino , Centro Germinal/inmunología , Centro Germinal/patología , Humanos , Inmunofenotipificación , Linfoma no Hodgkin/inmunología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Supratentoriales/inmunología , Neoplasias Supratentoriales/secundario , Centros de Atención TerciariaRESUMEN
PURPOSE: To evaluate the diagnostic potential of a multi-factor analysis of morphometric parameters and magnetic resonance (MR) signal characteristics of a mass and peritumoral area to distinguish solitary supratentorial metastasis from glioblastoma multiforme (GBM). MATERIALS AND METHODS: MR examinations of 51 patients with histologically proven GBM and 44 with a single supratentorial metastasis were evaluated. A large variety of morphologic criteria and MR signal characteristics in different sequences were analyzed. The data were subjected to logistic regression to investigate their ability to discriminate between GBM and cerebral metastasis. Receiver-operating characteristic (ROC) analysis was used to select an optimal cut-off point for prediction and to assess the predictive value in terms of sensitivity, specificity, and accuracy of the final model. RESULTS: The logistic regression analysis revealed that the ratio of the maximum diameter of the peritumoral area measured on T2-weighted images (d T2) to the maximum diameter of the enhancing mass area (d T1, post-contrast) is the only useful criterion to distinguish single supratentorial brain metastasis from GBM with a lower ratio favoring GBM (accuracy 68 %, sensitivity 84 % and specificity 45 %). The cut-off point for the ratio d T2/d T1 post-contrast was calculated as 2.35. CONCLUSION: Measurement of maximum diameters of the peritumoral area in relation to the enhancing mass can be evaluated easily in the clinical routine to discriminate GBM from solitary supratentorial metastasis with an accuracy comparable to that of advanced MRI techniques.
Asunto(s)
Neoplasias Encefálicas/patología , Imagen de Difusión por Resonancia Magnética/métodos , Glioblastoma/patología , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias Supratentoriales/patología , Neoplasias Supratentoriales/secundario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Adulto JovenAsunto(s)
Lóbulo Frontal/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Neoplasias Primarias Secundarias/diagnóstico por imagen , Radiofármacos , Neoplasias Supratentoriales/diagnóstico por imagen , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/tratamiento farmacológico , Carcinoma/radioterapia , Carcinoma/secundario , Carcinoma/cirugía , Terapia Combinada , Irradiación Craneana , Citarabina/administración & dosificación , Diagnóstico Diferencial , Senos Etmoidales/patología , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/etiología , Imagen por Resonancia Magnética , Neoplasias del Seno Maxilar/tratamiento farmacológico , Neoplasias del Seno Maxilar/radioterapia , Neoplasias del Seno Maxilar/cirugía , Metotrexato/administración & dosificación , Persona de Mediana Edad , Neoplasias de los Senos Paranasales/tratamiento farmacológico , Neoplasias de los Senos Paranasales/radioterapia , Neoplasias de los Senos Paranasales/cirugía , Radiofármacos/farmacocinética , Neoplasias Supratentoriales/tratamiento farmacológico , Neoplasias Supratentoriales/etiología , Neoplasias Supratentoriales/secundario , Tecnecio Tc 99m Sestamibi/farmacocinéticaRESUMEN
A set of one hundred and twenty nine patients with known primary malignancy and suspected brain metastasis was reviewed in present study. The patients were selected among patients presented to the MRI section of Imam Khomeini Hospital or a private MRI center in Tabriz (Iran). Primary tumor site, clinical manifestations, number and site of lesions were identified in this patient population. The primary tumor site was breast in 55 patients (42.6%), followed by lung (40.3%), kidney (7.7%), colorectal (4.6%), lymphoma (3.1%) and melanoma (1.5%). Most patients were presented with features of increased intracranial pressure (headaches and vomiting), seizures and focal neurologic signs. Single brain metastasis occurred in 16.3% of patients, while multiple lesions accounted for 83.7% of patients. Ninety seven patients had supratentorial metastases (75.2%). Twenty cases (15.5%) had metastases in both compartments. Infratentorial lesions were observed only in twelve patients (9.3%).
Asunto(s)
Neoplasias Encefálicas/secundario , Neoplasias Infratentoriales/secundario , Neoplasias Supratentoriales/secundario , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/epidemiología , Humanos , Neoplasias Infratentoriales/complicaciones , Neoplasias Infratentoriales/epidemiología , Hipertensión Intracraneal/etiología , Irán/epidemiología , Náusea/etiología , Estudios Retrospectivos , Convulsiones/etiología , Neoplasias Supratentoriales/complicaciones , Neoplasias Supratentoriales/epidemiología , Vómitos/etiologíaRESUMEN
We report four cases of patients with clinically isolated apathy which was mistaken for depression even though they were suffering from voluminous brain tumors. These cases remind us that rigorous clinical analysis is essential: searching for signs of organic origin or psychiatric etiology is fundamental to avoid an incorrect diagnosis. In particular, these four patients displayed anosmia, an uncommon symptom for patients suffering from depression. In addition, brain imaging is important to correctly identify the most prudent medical and/or surgical management strategy. In this short discussion, we propose an algorithm for the clinical diagnosis of apathy.
Asunto(s)
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Depresión/diagnóstico , Errores Diagnósticos , Senos Etmoidales/patología , Lóbulo Frontal/patología , Letargia/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Trastornos del Olfato/etiología , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias Supratentoriales/diagnóstico , Adenocarcinoma/complicaciones , Adenocarcinoma/psicología , Anciano , Trastornos del Conocimiento/etiología , Árboles de Decisión , Diagnóstico por Imagen , Epistaxis/etiología , Resultado Fatal , Femenino , Lóbulo Frontal/fisiopatología , Humanos , Letargia/etiología , Masculino , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/psicología , Meningioma/complicaciones , Meningioma/psicología , Persona de Mediana Edad , Trastornos del Olfato/fisiopatología , Neoplasias de los Senos Paranasales/patología , Neoplasias Supratentoriales/complicaciones , Neoplasias Supratentoriales/psicología , Neoplasias Supratentoriales/secundario , Carga Tumoral , Trastornos de la Visión/etiologíaRESUMEN
OBJECT: Reports on resection of tumors in or near eloquent cortices have noted neurological complications in up to 30% of patients. This paper contains an analysis of symptom resolution and neurological morbidity following 20-Gy Gamma Knife surgery (GKS) for supratentorial brain metastases < or = 2 cm in greatest diameter. METHODS: The authors performed a retrospective analysis of 98 consecutively treated adults (33 men and 65 women with a median age of 61.4 years at the time of GKS) with Karnofsky Performance Scale score > or = 60, who underwent GKS for supratentorial brain metastases < or = 2 cm in diameter. Lesion location was classified as noneloquent (Grade I), near eloquent (Grade II), or eloquent (Grade III), in accordance with the grading system developed by the group at M. D. Anderson Cancer Center. Following treatment, the patients underwent MR imaging and clinical examinations at 6 weeks and every 3 months thereafter. RESULTS: Ninety-eight patients underwent 20-Gy GKS for 131 metastases at initial presentation and 31 patients underwent salvage 20-Gy GKS for 76 new lesions, for a total of 207 lesions (mean lesion volume 0.44 cm3). Lesions were classified as follows: Grade I, 96 (46.4%); Grade II, 51 (24.6%); and Grade III, 60 (29%). Fifteen patients (2 with Grade II and 13 with Grade III lesions) presented with deficits referable to their lesions, yielding pre-GKS deficit rates of 7.2% per lesion and 15.3% per patient. The pre-GKS deficits improved or resolved in 10 patients (66.7%) at a median time of 2.8 months and remained stable in 3 patients (20%). Two patients (13.3%) experienced worsened neurological deficits. One patient who was neurologically intact prior to treatment developed a new hemiparesis (1 of 83 patients [1.2%]). The rates of permanent neurological deterioration following GKS for Grades I, II, and III lesions were 0% (0 of 96 tumors), 2% (1 of 51), and 3.3% (2 of 60), respectively. The pre-GKS neurological deficits and larger lesions were the most significant risk factors for post-GKS neurological deterioration. CONCLUSIONS: Gamma Knife surgery performed using a 20-Gy dose provides amelioration of neurological deficits from brain metastases that are < or = 2 cm in diameter and located in or near eloquent cortices in nearly two-thirds of patients with a low incidence of morbidity. Consistent with the surgical literature, higher rates of neurological complications were observed as proximity to eloquent regions and lesion size increased. There was no neurological deterioration in patients harboring metastases in noneloquent areas.
Asunto(s)
Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Corteza Cerebral/patología , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Radiocirugia/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/patología , Causas de Muerte , Progresión de la Enfermedad , Determinación de Punto Final , Femenino , Estudios de Seguimiento , Humanos , Estado de Ejecución de Karnofsky , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Supratentoriales/secundario , Neoplasias Supratentoriales/cirugía , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Adenocarcinoma Folicular/secundario , Lóbulo Occipital/patología , Neoplasias Supratentoriales/secundario , Neoplasias de la Tiroides/patología , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/radioterapia , Errores Diagnósticos , Resultado Fatal , Femenino , Bocio Nodular/diagnóstico , Adhesión a Directriz , Humanos , Radioisótopos de Yodo/uso terapéutico , Persona de Mediana Edad , Invasividad Neoplásica , Guías de Práctica Clínica como Asunto , Pronóstico , Neoplasias Supratentoriales/radioterapia , Neoplasias de la Tiroides/diagnóstico , Tiroidectomía/métodosRESUMEN
Although germ cell tumors are the most common malignancy in young men, extragonadal germ cell tumors are rare. Gastric metastasis presenting initially as upper gastrointestinal hemorrhage is also exceedingly rare. A 27-year-old man presented at our hospital with tarry stool. Gastric fiberscopy images revealed a bleeding gastric polypoid lesion in the anterior wall of the gastric body, from which a biopsy specimen was obtained. Histopathological analysis of the biopsy showed syncytiotrophoblast-like cells with multiple, large nuclei, consistent with choriocarcinoma. Based on these results, our diagnosis was extragonadal retroperitoneal germ cell tumor with gastric metastasis.
Asunto(s)
Coriocarcinoma/secundario , Hemorragia Gastrointestinal/etiología , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Gástricas/secundario , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Bleomicina/administración & dosificación , Coriocarcinoma/complicaciones , Coriocarcinoma/diagnóstico , Coriocarcinoma/tratamiento farmacológico , Coriocarcinoma/patología , Coriocarcinoma/cirugía , Gonadotropina Coriónica/sangre , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Cisplatino/administración & dosificación , Terapia Combinada , Etopósido/administración & dosificación , Gastroscopía , Humanos , Ifosfamida/administración & dosificación , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Masculino , Lóbulo Occipital/patología , Lóbulo Occipital/cirugía , Inducción de Remisión , Neoplasias Retroperitoneales/complicaciones , Neoplasias Retroperitoneales/tratamiento farmacológico , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Neoplasias Supratentoriales/tratamiento farmacológico , Neoplasias Supratentoriales/secundario , Neoplasias Supratentoriales/cirugía , Cirugía Torácica Asistida por VideoRESUMEN
A 61-year-old man presented with an extremely rare neoplastic cerebral aneurysm caused by brain metastasis from pleomorphic lung carcinoma manifesting as intracerebral hematoma and sudden onset of semicoma. Computed tomography demonstrated huge intracerebral hemorrhage in the left cerebral hemisphere, which had collapsed into the lateral ventricle. Cerebral angiography disclosed a fusiform aneurysm in the periphery of the left middle cerebral artery (approximately 2 mm diameter). Resection of the aneurysm and removal of the hematoma were performed. Histological examination revealed that the aneurysm walls were invaded by pleomorphic carcinoma. The present case indicates that neoplastic cerebral aneurysm may be the cause of intracerebral hemorrhage in patients with pleomorphic lung carcinoma.