Intraspinal Neurenteric Cystの1例

A CASE OF INTRASPINAL NEURENTERIC CYST

はじめに

　Intraspinal neurenteric cystに相当するものは，1928年Kubie-Fulton^28）が脊髄の奇形嚢胞腫（teratoma—tous cyst）として2例を報告して以来entodermal cyst，enterogeneous cystなどと様々な名称で呼ばれ，筆者が調べ得た限りでは57例の報告がある。臨床上経験されることはまれであり，自験例を報告すると共に，統計的，文献的考察を合わせて論じる。

A case of neurenteric cyst was associated a pit-like defect of the anterior vertebral body. A 14-year-old japanese boy has had the recurrent episodes of hit on his upper back twice at 11 year and 13 year of his age. Each a week and a month later, he had been sufferred from pains in the upper back and in the bilateral elbows. It was relieved each during the one week and the one month admissions.

At 14 years old, he has felt pains in the upper back and in the bilateral elbows, followed by motor and sensory impairement of the bilateral legs. Within the later 2 months, motor weakness gradu-ally developed and he became not to be able to walk. He was also sufferred from uninary reten-sion. He was admitted our hospital showing nuchal rigidity, slight muscle atrophy of the bilateral arms with decreasing grasping power and paraplegia. Accelerated deep tendon reflexes, positive clonus are remarkable in the right. Positive Babinskii re-flexes, absent abdominal and cremasteric reflexes are seen bilaterally. The superficial sensation was impaired in the lower part of body below Th 3 level, and the deep sensation was impaired in the bilateral legs. Urinary retension was also contin-ued. The initial pressure of spinal tap was 160 mmH₂O showing watery clear CSF with positiveQueckenstedt's test. CSF protein was slightly high. Air myelography did not reveal stenosis however the myelography infusing Myodil oil from the lumbar level showed U-shaped shadow defect at Th 1 and C7 level. The 42% of literatures reported additional vertebral anomalies and this case reveal-ed a pit like defect at the anterior surface of Th 1 vertebral body on anterior posterior view of plane X-ray.

A laminectomy over C5 through Th 1 levels dis-closed slight tension on the dura. A grey white cyst was located at the left anterior root. Approxi-mately 5 cc of yellow transparent fluid was drained by punctation, and pulsating movement of the spinal cord was begunn when the spinal cord was placed normally. The cyst was removed and histol-ogically the inner surface of the cyst was lined by a single layered collumnar epithelial cells which are partially deformed to be flat or cylindrical. Histochemically, the cytoplasms of the majority cells showed negative in alcian blue-PAS, toluidine blue and partially the globoid cells are positive in alcian blue and weak positive in PAS stain.

Many literatures reported that the lining of ciliated collumnar epithelial cells suggested entero-geneous cells, however these cells were also could be thought to be respiratory epithelial cells. In this stand point of view that the nature of epithe-lial cells might be intestinal and/or might be res-piratory, but entodermal. The "neuro-entodermal cyst" is an appropiate histological term as Dr. Tokoro states.

Emgryogenesis of the anomalies is also discussed.