脊髄圧迫症状を呈し，頭蓋骨転移をきたした悪性胸腺腫の1例

A CASE OF MALIGNANT THYMOMA WITH SPINAL COMPRESSION SYMPTOM AND METASTASES TO THE SKULL

I．まえがき

　悪性胸腺腫は比較的まれな疾患とされているが，その定義・分類が確定され出したのは比較的近年になつてからである。

　われわれは最近，下半身知覚・運動麻痺を主訴として来院した10歳の女児で，臨床上脊髄硬膜外腫瘍として摘出術を行ない，その後，定位脳手術を行なう際，頭蓋骨穿孔直下の硬膜上に転移腫瘍を認め，剖検で初めて悪性胸腺腫と判明した興味ある1例を経験したので報告する。

A 10 year old girl was admitted to our hospital on Mar. 27, 1967, complaining of sudden sensory and motor disturbance in the lower half of her body. No pathological findings could be obtained in plain X-ray films of the spine and chest, but an ascending myelography revealed an epidural spinal tumor at T4. Laminectomies from T₄ to T₁ were carried out and a gray, soft and ill circumscribed epidural mass, about 5×1×0.5cm in size, was exstirpated. The pathological diagnosis of this specimen was then !nodeas neuroblastoma, which was corrected later to re-ticulosarcoma by re-examination. After the post-operative irradiation therapy, the patient was dis-charged with a good improvement on July 22, 1967. She was readmitted on Sept. 1, 1967, due to the recurrence of spinal symptom. The tumors were then observed in the upper left thorax, left supra-clavicular region and frontal region. Biopsy of the epidural mass in the frontal region was performed during anterior cryocingulumotomy for intractable pain in the left shoulder and upper extremity. Medul-loblastoma was suspected by the pathological exami-nation of this biopsy material. In spite of irradia-tion and administration of cyclophosphamide, the patient expired on Dec. 2, that year.

Postmortem examination revealed upper thoracic tumor mass en bloc, intrathoracic plantation, invasion to the upper thoracic spine and metastases to the skull. The final pathological diagnosis by gross and microscopic findings was malignant thymoma.

This case of malignant thymoma with initial symp-tom of spinal compression and metastases to the skull is believed to be a very rare one.