レ線治療約5年後死亡した1松果体腫剖検例の検討

ON AN AUTOPSY CASE OF THE PINEALOMA TREATED WITH IRRADIATION FOR FIVE YEARS

I．緒言

　松果体部腫瘍に対する外科的治療は，その解剖生理学的関係より，全頭蓋内腫瘍中，最も困難なものの一つとされていたが，他方真性の松果体腫（Pinealoma）はレ線感受性の大きいことより，照射療法の有効性も認められている。

　私どもは，全摘術を試みたが，出血がきわめて多かつたので，これを断念したPinealoma例（組織学的に確定）に，術後数回にわたる大量放射線照射療法により，ほとんど無症状に経過したが，約5年後，再発症状をきたして死亡した1例を経験したので，その概要を述べるとともに，剖検所見を報告し，特にレ線治療の効果，腫瘍組織像の時期的変遷，臨床症状と剖検所見の関連性などにつき若干の考察を加えた。

Comparing with the incidence of teratoid and tera-tom of primarily intracranial origin, pure mesodermal mixed tumor is said to be extremely rare.

A case of mesodermal mixed tumor ascertained by operation was reported. This tumor showed malignant change in a part of it, sudden rapid growth and dis-semination of two daughter tumors.

21 aged man had complained of transient right sided hearing disturbance about one year before ad-mission.

Four months prior to admission, he suffered from visual disturbance and one month later symptoms of ncreased intracranial pressure appeared. Two months prior to admission, a nut sized tumor was able to be palpated over the scalp at the right temporal region, and these made him bring to our clinic. All these symptoms and signs coursed in one year.

It was proved by operation that a nut sized tumor protruded through the temporal bone was a part of a tennis ball sized tumor (40g) located intradurally under the temporal lobe. Two daughter tumors (each 10g) were extirpated. These tumors were solitary and had no communication with each other.

Histological examination revealed that it was an osteochondroma. The extradural part of the big tumor and two daughter tumors showed malignancy. These tumors were not considered as multicentric but that the big tumor had undergone malignant change and produced the dissemination of these daughter tumors.