Unusual Intracerebral Hemorrhage as a Postoperative Complication of A Metastatic Tumor

摘要

Described here is an unusual complication after diagnostic biopsy for brain metastasis.We admitted a 39-year-old male patient with history of recent onset seizure. MRI revealed multiple lesion . Workup to diagnosis of metastasis was negative. He underwent a lesionectomy. Histological examination identified metastatic adenocarcinoma. After the surgery hemorrhage in corpus callosum deteriorated his neurological status. Brain metastases represent a significant source of morbidity and mortality in patients with systemic cancer. Among adults, the highest incidence is observed in the fifth to seventh decades of life[1]. The most common sources of brain metastases in this patient group are cancers of the lung, breast, and skin, in descending order[2]. As many as 10% to 15% of patients with a clinical diagnosis of metastasis may, in fact, have nonmetastatic lesions such as abscesses or primary tumors[3]. So in patients without known primary site of tumor, sampling can provide tissue for confirming the diagnosis of metastasis. In other hands post operative hemorrhage has been known as a complication of surgery. Case presentation The patient is a 39-year old male without serious previous disease or family history of cancer. In November 2007, he had an episode of generalized seizure resulting in hospitalization. His physical examination was normal. A magnetic resonance imaging (MRI) scan of the brain with and without contrast revealed multiple lesions in temporal and right parietal lobe and corpus collosum with enhancement, presumably representing metastatic brain lesions(Figure 1). The metastasis workup, including chest-XRay ,computed tomographic (CT) scans of the thorax, abdomen, and pelvis, did not reveal any tumor. Lab exam was in normal value and no bleeding tendency in the hematological examination was found. The PET was not accessible to us. In December 2007, the patient was admitted in our hospital for diagnostic biopsy.the new brain CT scan was performed that revealed a new lesion in the right subfrontal area (fig 2).