[A case of primary fibrosarcoma caused by spontaneous intracerebral hematoma]

A rare case of repeated intracerebral hematoma associated with an intracerebral fibrosarcoma is reported. A 43-year-old man was referred to our clinic with headache and vomiting of sudden onset. On admission, he was lethargic. CT revealed a huge intracerebral hematoma in the left temporal lobe with midline shift. Angiography failed to demonstrate any evidence of an intracranial tumor. An operation was performed under the diagnosis of an idiopathic cerebral hematoma. The postoperative course was uneventful and he was discharged without any deficits except for a left upper quadrant homonymous hemianopia. Four and a half months after the first operation, he was readmitted to our clinic with the same symptoms as he had at the first admission. Neuroradiological examination again revealed an intracerebral hematoma in the left temporal lobe. At operation, a pinkish-gray discolored mass at the hematoma wall was found. An intraoperative histological examination of the mass indicated a malignant tumor and the tumor was totally removed. However the patient did not recover from the severe neurological deficits and died 3 months after the second surgery. Histological examinations of the tumor demonstrated a typical fibrosarcoma. Intracerebral primary fibrosarcoma with hemorrhage is quite rare. In such a case with a large hematoma, the presence of a tumor may be obscured on CT scan and angiography. Detailed observation of the hematoma wall using an operating microscope should be performed to allow a correct diagnosis.