免疫関連の脳炎を模倣する膀がんによる癌性レプトメニング炎:症例報告
Filippo Cordaro1, Andrea Barresi1, Francesco Bencivinni2
1Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy.
まとめ
レプトメニンゲアルがんは,珍しい膀がんの合併症で,特異的な症状はありません. このケースは 診断の難しさ 特に免疫療法の難しさと 迅速な評価の必要性を強調しています
科学分野:
- 腫瘍学
- 神経学
背景:
- 喫煙歴,高血圧,血脂不全の 65 歳の男性に 血脂不全と血症が出現した.
- 画像検査では,筋肉侵襲性膀がんと直腸の加厚が示され,生検により,高度の泌尿器がん (pT2) と直腸腺がんが確認された.
研究 の 目的:
- 尿路がんに次発したレプトメニンゲアルがんの 珍しい症例を報告する.
- この希少な合併症の診断の課題と管理について,特に免疫療法を受けている患者について議論する.
主な方法:
- 腫瘍のステージと神経学的評価のためのコントラスト強化CTとMRIスキャン.
- 診断のための生検と脳脊髄液 (CSF) の細胞学的検査.
- 治療には化学療法 (ゲムシタビン/シスプラチン,それからカルボプラチン),放射線療法,免疫療法 (アヴェルマブ) が含まれていた.
主要な成果:
- 患者は免疫療法の開始後に神経学的症状 (首の痛み,姿勢の不安定) を発症した.
- 神経画像は小脳腫れと乳頭臓の強化を示し,当初はパラネオプラスティックまたは免疫療法に関連した効果であると疑われた.
- 遠隔転移に対するPET-CTの初期否定的な結果にもかかわらず,CSFの分析により,尿路起源のレプトメニンゲル転移が確認されました.
結論:
- レプトメニンゲアルがんは尿路がんの希少だが重大な症状である.
- 非特異的な症状と免疫療法による副作用が重なり合っているため,診断は困難である.
- 早期の神経イメージングとCSF細胞検査は極めて重要で,治療は主に緩和的なものです.
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