甲状腺癌の頭蓋骨転移

SKULL METASTASIS OF MALIGNANT STRUMA

Ｉ．緒言

　甲状腺癌の骨転移は必ずしもまれではないが，頭蓋骨転移に関してはこれまでまとまつた報告はみられない。我々は10例の甲状腺癌の頭蓋骨転移を経験したが，そのうち9例は頭蓋穹隆部のものでいずれも半球状に椀を伏せた形状であり，1例は頭蓋底部でこれまた球状に近い形で硬膜外に発育しており，極めて特徴ある形態を示しており，また組織学的，その他にも特徴ある所見を呈し，診断上極めて興味ある結果を得たので報告する。

In our series of malignant struma of 307 cases from 1950 to 1970, bone metastasis was found on 19 cases in which the number of cases of skull metastasis was 10 (3.3%).

In this report, 10 cases of skull metastasis of malignant struma were reported and discussed.

Over middle aged female patients with the soft and hemispheric shaped head tumor have to be suspected the skull metastasis of the malignant struma and its diagnosis will become more certain when the osteolytic bone defect is revealed on the plain film and the tumor is feeded with many arteries in the arteriogram, in addition the findings of struma is presented or in the past history.

Five patients were suspected the skull metastasis of malignant struma, because of only the specific figure of head tumor just like the hemispheric shape without subjective symptomes of struma. Skull base metastasis was only one case which was difficult to make a diagnosis at the outpatient clinic. 5 cases with the metastasis except the skull were discovered the other metastasis by the X-ray or radioiodine (¹³¹I) examination. As to the treatment, total ex-tirpation of struma as a primary focus and of the metastatic focus should be performed as far as possible.

Then internal radiation therapy by the radioiodine have to be followed after the radioiodine up take was activated by TSH. In case of low radioiodine up take, external radiation therapy must be suitable.