頭蓋内腫瘤形成を初発症状とした単球性白血病の1例

A CASE OF MONOCYTIC LEUKEMIA CLINICALLY BEGINNING WITH AN INTRACRANIAL MASS FORMATION

I．はじめに

　造血組織の悪性疾患である白血病はその経過中に神経症状をひきおこすことはよく知られている^1）2）3）。最近わたくしどもは初発症状として，あたかも慢性硬膜下血腫のような症状とレ線所見を呈し，手術によつて硬膜下に実質性腫瘤を発見し，その術後の経過中はじめて末梢血に白血球の増加および幼若細胞の出現などをきたしたが，化学療法によつて一応の緩解をみるに至ったきわめてめずらしい白血病の1例を経験した。頭蓋内に腫瘤を形成してくる白血病はめずらしく，その報告も数少ないものであり，わたくしどもの症例を報告し，あわせて文献的に考察を述べる。

This case of monocytic leucemia is reported be-cause of the rarity of the clinical onset and course.

The patient was a 31 year old man, who was admitted to our clinic with the symptoms of in-tracranial hypertension on September 22, 1966. Af-ter a clinical diagnosis of intracranial space occupying lesion, probably subdural hematoma in the right frontoparietal region, had been made by right carotid angiography and other neurologic examinations, a craniotomy was performed. However, no hematoma was found, and the surface of the rightfrontoparietal cortex was covered by a thin, yellowish-grey tumor mass which partially invaded into the right frontal lobe. The tumor was sub-totally removed as much as possible. The histopathological diagnosis was in-conclusive, but a suspicion of malignant lymphoma was entertained.

The postoperative course was uneventful. How-ever, following the 60Co radiation therapy (75 days after surgery), the white blood cell counts markedly increased on a sudden, and the examinations of blood smears and bone marrow specimens revealed mono-cytic leukemia. On the reflection of these results, only possible explanations are that the brain tumor was of the process of monocytic leukemia.

The patient was successfully treated with cytos-tatic agents-6 mercaptopurine, methotrexate, etc.-, steroid hormone and infusions of fresh blood, and was discharged home on February, 1967. The patient is alive now (December, 1967).