每日一题_2023.07.21

A 61-year-old man with a medical history of cancer presents with a two-week history of constant and severe headaches that are most severe when he wakes up in the morning. He also notes changes in vision associated with the headaches. Physical examination shows a healing ecchymotic lesion on the right forearm, papilledema in the left eye, a right-sided pronator drift, and weakness of the right arm. The diagnosis of an intracranial hemorrhage is confirmed with CT of the head. Which of the following cancers is most likely to have resulted in this patient’s presentation?

一名有癌症病史的61岁男性有两周的持续重度头痛病史，早晨醒来时最严重。他还指出了与头痛相关的视力变化。体格检查显示右前臂愈合的瘀斑病变、左眼视乳头水肿、右侧旋前肌漂移和右臂无力。颅内出血的诊断由头部的CT证实。以下哪种癌症最有可能导致该患者的临床表现?

(A) Angiosarcoma 血管肉瘤

(B) Basal cell carcinoma 基底细胞癌

(C) Colorectal carcinoma 结直肠癌

(D) Melanoma 黑色素瘤

(E) Prostate cancer 前列腺癌

答案解析：

颅内转移占所有脑肿瘤的近一半，但只有15%的肿瘤转移到脑。颅内出血是脑肿瘤公认但相对少见的并发症，可导致脑实质内、蛛网膜下腔、硬膜下和硬膜外血肿。局灶性神经系统体征通常很明显，是由于施加在脑实质上的压力所致。因为黑色素瘤是脑转移瘤的一个相对常见的来源(虽然比乳腺癌或肺癌少)，并且表现出十度的出血倾向，所以黑素瘤是这个病例的正确答案。

正确答案：D