We report a rare autopsy case in which the patient received gastrectomy after an endoscopic diagnosis of early gastric cancer, and had deteriorated due to exclusive metastatic cerebellar tumors identified 14 months after surgery. A 65-year-old male was diagnosed as having a 0-IIc-type early gastric cancer on the posterior wall of the upper stomach by gastrointestinal endoscopy in search of a cause of epigastralgia, and thus received proximal gastrectomy and pyloroplasty. Although the tumor was in the early stages and limited within the mucosal layer, adjuvant chemotherapy was started by using S-1 80 mg daily due to evidence of metastasis into lymph node #3 at the lesser curvature. Evidence of both recurrence and metastases was not detected by CT scans of the chest, abdomen, and pelvis, and the chemotherapy was completed 12 months after surgery. However, the patient was admitted to hospital 14 months postoperatively due to dizziness and gait disturbance. Cranial MRI (Magnetic Resonance Imaging) revealed multiple tumors in the bilateral cerebellar hemispheres with additional leptomeningeal involvement. The patient died 2 weeks after admission. An autopsy revealed metastatic cerebellar tumors and leptomeningeal lesions from the early gastric cancer, and obstructive hydrocephalus due to metastatic cerebellar tumors. To our knowledge, this case is the first report of metastasis exclusive to the cerebellum and leptomeninges from early gastric cancer limited to the mucosal layer.

Urachal cancers usually do not metastasize until the late stages, and local invasion and recurrence are observed with high frequency. We report a rare case of brain metastasis from urachal cancer in a 67-year-old female. She presented with abnormal behavior and right hemiparesis that started one month previously. MRI revealed a 55-mm lesion in the left frontal lobe, 5-mm in the right parietal lobe, and 2-mm lesion in the left cerebellum. The tumors showed ring enhancement on gadolinium-enhanced T1WI and were suspected to be metastatic brain tumors. Craniotomy was performed to excise the biggest tumor;the histological diagnosis was a poorly differentiated adenocarcinoma. As a result of the search for the primary tumor, the urachal carcinoma and multiple lung metastases were found. The patient chose best supportive care after diagnosis and died due to progression of multiple systemic metastases five months after surgery.

鎖骨頭蓋骨異形成症（cleidocranial dysplasia: CCD）は，発症率が約20 万人に1 人とされる比較的稀な先天性の骨系統疾患である．今回，本症候群に両側中大脳動脈瘤を合併した症例を経験したので報告する．症例は87 歳，女性で，歩行障害を主訴に来院した．CT 上，左脳内出血・左シルビウス裂のくも膜下出血を認め，3DCTA にて両側中大脳動脈瘤を認めた．また初診時の特異な顔貌・体躯，レントゲン検査・骨条件の3DCT からCCD と診断した．左中大脳動脈瘤破裂によるくも膜下出血を疑い，同部のクリッピング術を行ったが，術中所見では未破裂であり，外傷性のくも膜下出血であったと判断した．術後経過は問題なく，発症前のADL と変わらずに自宅退院した．CCDに脳動脈瘤を合併した報告はこれまで1 例のみであり，本症例は極めて稀な症例であると思われた．

We conducted a case series study to assess intracerebral hemorrhage (ICH) in the context of anti-platelets agents (APAs) and platelet (PLT) transfusion in Fukushima Prefecture.This study included patients who were newly diagnosed with ICH between January 2008 and June 2014 in the neurosurgical hospitals of Fukushima Prefecture.　Four of ten neurosurgical hospitals responded to our questionnaire.　Of 287 ICH patients, 51 (20.6%) were on APA therapy, of whom PLT transfusion was given to only one persistently bleeding patient who was on dual anti-platelet therapy.　In a follow-up survey, 30 out of 51 ICH patients on APA therapy, average age 75 years, were analyzed, of whom 21 (70%) were male.　The predominant underlying disease was diabetes mellitus.　It is interesting to note that peripheral artery disease and aortic aneurysm were among the indications for APAs.　ICH was mainly observed supratentorially.　Hematoma enlargement was observed in 13 (44.8%) cases.　By day 7, 3 patients (10%) had died from complications of ICH.　In this study, we show that ICH during APA therapy matched what was observed in Kanagawa Prefecture.　Whether or not a national survey differs, we anticipate greater statistical validity and an opportunity to improve patient outcomes in Japan and around the world.