PDF(Pubmed)
Abstract：
Brain metastases are the most common type of brain tumor in adults, commonly arising from primary tumor sites of the lung, breast, skin (melanoma), colon, and kidney. Isolated central nervous system (CNS) metastasis arising from urothelial carcinoma (UC) is a rare presentation yielding a poor prognosis. A 71-year-old male patient with a history of urothelial carcinoma, treated one year prior with partial cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented with worsening neurological symptoms, including progressively worsening dizziness, shuffling gait, drifting, expressive aphasia, and confusion. MRI revealed a left frontal 4.0 x 3.6 cm brightly contrast-enhancing tumor with possible hemorrhage, extensive vasogenic edema, and moderate mass effect. An additional smaller right cerebellar lesion was also noted. Outpatient CT of his chest, abdomen, and pelvis revealed no evidence of other malignant sites. He ultimately underwent a left craniotomy with a total resection of his left frontal mass. Pathological examination revealed a urothelial primary. Post-operative MRI revealed complete resection of the left frontal mass and the patient was discharged with no neurologic deficits on exam. In many cases, brain metastases may present years later following initial therapy of UC as the CNS may act as a sanctuary site during systemic chemotherapy. Chemotherapeutics such as gemcitabine with better penetration of the blood-brain barrier may be beneficial in delaying the onset of these metastases.
摘要：
脑转移瘤是成人脑肿瘤最常见的类型，通常来自肺部的原发肿瘤部位，乳房,皮肤（黑色素瘤），结肠,还有肾.由尿路上皮癌（UC）引起的孤立的中枢神经系统（CNS）转移是一种罕见的表现，预后不良。一名71岁的男性患者，有尿路上皮癌病史，一年前接受部分膀胱切除术和吉西他滨和顺铂（GC）辅助治疗，神经症状恶化，包括逐渐恶化的头晕，洗牌步态，漂流,表现性失语症，和困惑。MRI显示左额叶4.0x3.6cm明亮的对比增强肿瘤，可能有出血，广泛的血管源性水肿，和中等质量效应。还注意到另一个较小的右小脑病变。他胸部的门诊CT,腹部，骨盆没有发现其他恶性部位.他最终接受了左开颅手术，并完全切除了左额叶肿块。病理检查显示尿路上皮原发性。术后MRI显示左额叶肿块完全切除，患者出院，检查无神经功能缺损。在许多情况下,UC初始治疗后数年后可能出现脑转移,因为CNS可能在全身化疗期间充当避难所.具有更好的血脑屏障渗透的化学治疗剂如吉西他滨可能有益于延迟这些转移的发作。
