“脑先行型”转移瘤的诊断及原发灶的寻找

Diagnosis and the Locating of Primary Tumors in Patients with Cerebral Preceding Metastatic Cancers

背景与目的:"脑先行型"转移瘤患者既往无肿瘤病史,以神经系统症状为首发,临床容易被误诊,部分患者确定原发灶的部位存在一定困难。本文总结26例患者临床特点,探讨"脑先行型"转移瘤的诊断要点及如何迅速、准确确定原发灶的部位。方法:回顾性分析1993年1月至2004年3月间在本院诊治的26例"脑先行型"转移瘤患者的临床资料。结果:26例患者中,男性18例,女性8例,平均年龄59.8岁。病程1天～8个月,平均1.8个月。以头痛、呕吐、视乳头水肿为主要临床表现。单发脑转移11例,多发15例。首诊误诊者有5例,2例误诊为胶质瘤,2例为脑脓肿,1例脑转移合并出血误诊为高血压脑出血。原发肿瘤大腿皮肤痣1例,肺癌22例,原发灶未查出者3例。结论:"脑先行型"转移瘤主要见于中老年人,临床上易与中枢神经系统原发疾病相混淆,误诊率高。"脑先行型"转移瘤最常见的原发灶是肺癌。寻找原发灶是"脑先行型"转移瘤诊断过程中关键一步,按照正确的步骤寻找,常能够迅速、准确的发现原发灶,为治疗争取时间。

BACKGROUND & OBJECTIVES:Patients with cerebral proceeding metastatic cancers (CPMCs)present first with neurological symptoms without a history of tumor and manifestation of primary tumors. CPMCs are readily to be misdiagnosed.It is difficult to locate the primary tumor in some of patients with CPMCs. In this study,twenty-six eases with CPMCs were retrospectively analyzed.Diagnosis of CPMCs and procedures to locate the primary tumor were discussed.METHODS:Patients with CPMCs referred to Cancer Center,Sun Yat-sen University from January 1993 to March 2004 were retrospectively analyzed.RESULTS:Twenty-six pa- tients with CPMCs were referred to Cancer Center,Sun Yat-sen University.There were 18 men and 8 women. The average age was 59.8 years old.The average course of diseases was 1.8 months,ranging from 1 day to 8 months.Headache,nausea and vomiting,edema of optic disc were the common symptoms and signs.The number of patients with single and multiple brain metastases was 11 and 15 respectively.In all patients,two cases were misdiagnosed as gliomas,two as cerebral abscess and one case with hemorrhage as hypertensive hemorrhage.CON- CLUSION:CPMC is a rare circumstance of BMs,and occurred in old people.Patients with CPMCs usually ap- pear as fist symptom of dizziness,headache or dyskinesia and then after to be confirmed as metastatic brain tu- mors.It was readily misdiagnosed with prima- ry brain tumors.Lung cancer was the most com- mon origin of CPMCs and adenoma was the most common pathological type.To locate the origin of CPMCs was the key point in diagno- sis.The primary tumors could be found out quickly and correctly by following an appropriate work-up scheme.