| 뇌전이암의 임상적 고찰 |
| 황연미, 김원천, 최일생, 김기환 |
| 연세대학교 신경과. |
| A Clinical Study on Intracerebral Metastatic Tumors |
| Youn-Mee Hwang, M.D., Won-Tsen Kim, M.D., Il-Saing Choi, M.D., Ki-Whan Kim, M.D. |
| Department of Neurology, Yeonsei University College of Medicine, Seoul, Korea |
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| Abstract |
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Intracerebral metastases are among the most feared complication of systemic malignant disease and most occur late in the course of the systemic cancer so often are viewed as a terminal maifestation for which diagnosis and treatment are neigher required nor desirable. However, this situation is changing. Improved survival rates with many kinds of cancer have led increasingly to instances where the neurologic complications themselves limit the quality of life, forcing physicians to assume a more active attitude toward the diagnosis and treatment of the neurologic disorder. The authors analysed 125 cases of intracerebral metastatic tumors which are diagnosed with the brain CT scan at Yonsei University, Severance Hospital from January, 1979 to December, 1984 and following results were obtained. 1. Intracerebral metastatic tumors are found in 125 cases(31.2%) of all intracranial neoplasm. 2. The most common primary tumor is lung ca. (50.4%) followed by chorioca. (8%), breast ca. (8%) and GI tract ca. (6.4%) in the order while 16 casese (12.8%) were of unknown primary tumor. 3. Chorioca. (14.9%), melanoma(5.6%), lung ca.(4.2%), kidney ca.(3.3%) and breast ca.(2.3%) exhibit relatively high rate of intracerebral metastasis in the order whereas stomach ca.(0.2%), hepatoma (0.3%) and cervix ca (0.1%), which constitute most common primary maliqnancies in Korea, revealed very low rate of intracerebral metastasis.
4. The youngest patient was 11 years old and the oldest 80. Most intracerebral
metastatic tumors, 97%, occur above 30 years of age and peak in the 6th decade (32%).
In age below 40, chorioca. Is the most common pimary tumor and the age above 40,
lung ca. 5. There is no sexual difference between male and female. In male most
conmon primary site is lung (64.6%) followed by GI tract(7.7%)and in female, lung
(35%), chorioca. (16.7%) in the order.
6. The most common presenting symptom and sign is headache (58.4%) followed by
motor deficit (48.0%), mental deterioration (43.2%) and nausea or vomiting (32.8%). 7.
In most of intracerebral metastases the onset is gradual with duration of less than 3
months in 84% whereas in a few patients, 8 cases (6.4%), the onset is apoplectic and
the primary sites that revealed apoplectic onset are lun. (3 cases), chorioca. (3 cases),
liver (3 cases), unknown (1 cases).
8. Intracerebral metastases are detected simultaneously (50.5%), precociously (3.7%) or
after (45.9%) diagnosis of the primary tumor. 9. Average interval between the diagnosis
of primary tumor and development of intracerebral metastasis is 9.1 months in total and
short in lung, stomach, kidney and liver cancer whereas and long in breast, rectum
cancer and sarcoma. 10. In 96 cases who can be reevaluated with brain CT, the
findings are as follows; 1) Metastatic lesions are multiple in 67.7% and single in 32.3%.
2) Most intracerebral metastases are located supratentorially (77.%), in 4.2%;
infratentorially and in 18.8%; both. 3) Density of lesions are variable from hypodense
to hyperdense and intracerebral metastases from chorioca., breast, kidney and
nasopharynx ca. Are likely to iso to hyper than hypodense. Calcifications are rare and
observed only in 2 cases (2%). 4) Most cases (98.5%) reveal perifocal edema of
variable degree while a few patients (11.5%) reveal no edema. 5) Most metastatic
lesions demonstrate variable contrast enhancement with nodular type (52.1%), rign type
(25.0%), combined (15.6%) and a few patients (7.3%) fail to enhance. 6) Hemorrhages
are found in 11 cases (11.5%) and chorioca. (4 cases), hepatoma 3 cases) and lung ca,
(3 cases) are the most frequent offenders.
11. Radiation, surgery and chemotherapy seems to improve the prognosis. |
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