동측반맹을 보인 뇌전이 간세포암
Occipital Lobe Metastasis of Hepatocellular Carcinoma Presenting as Homonymous Hemianopia
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목적: 우측 후두엽에 전이된 간세포암에 의해 시야검사에서 동측반맹 소견을 보였기에 이를 보고하고자 한다. 증례요약: 19개월 전 간세포암으로 타 병원에서 간절제술을 받은 기왕력이 있는 51세 여자 환자가 몇 달 전부터 발생한 두통과 시력저하를 주소로 내원하였다. 나안 시력은 양안 각각 1.0이었고, 험프리자동시야검사에서 좌측 동측반맹을 보였다. 이 외 안과적 소견은 정상이었다. 뇌자기공명영상검사에서 우측 후두엽에 전이가 의심되는 거대한 종양이 있어 개두술과 종양절제술을 시행하였고, 조직검사에서 간세포암이 확진되었다. 결론: 간세포암의 기왕력이 있는 환자가 동측반맹의 시야 이상을 보이는 경우, 매우 드물지만 간세포암의 뇌전이의 가능성도 고려하여야 한다.
Abstract
Purpose: To report brain metastasis of hepatocellular carcinoma presenting as homonymous hemianopia. Case summary: A 51-year-old female with a history of hepatectomy and diagnosis of hepatocellular carcinoma (HCC) 19 months earlier was referred to our neuro-ophthalmology clinic for evaluation due to headache and decreased visual acuity over the past several months. Best visual acuity was 20/20, and the results of all other aspects of our examination were normal except Humphrey automatic perimetry, which showed complete left homonymous hemianopia. Brain magnetic resonance imaging showed a large mass in the right occipital lobe. Craniotomy and removal of tumor were performed. HCC was confirmed by histopathologic examination. Conclusions: Metastasis of hepatocellular carcinoma to the occipital lobe is extremely rare but can present as homonymous hemianopia. Therefore, clinicians should be aware of this when examining a patient with a history of HCC.
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