急性骨髄性白血病で死亡した脊髄硬膜外悪性リンパ腫の1例

A CASE OF MALIGNANT LYMPHOMA IN THE SPINAL EPIDURAL SPACE TERMINATING IN THE ACUTE MYELOGENOUS LEUKEMIA

I．はじめに

　Malignant lymphomaが，その経過中に，白血病の形態をとる事は，1905年Strenberg^9）が報告して以来，よく知られており，それは血管あるいは骨髄への浸潤で説明されている。しかし，malignant lylnphomaの1つであるreticulum cell sarcomaが白血病へ転化する事は，比較的稀である。我々は，最初神経症状で，発病し，脊髄硬膜外腫瘤剔出後，初めて末梢白血球数が急増し，骨髄性白血病となつて死亡した症例を経験したので，若干の文献的考察を加えて，これを報告する。

A case of malignant lymphoma in the spinalepidural space terminating in the acute myelogenousleukemia was reported, and the relationship betweenthe two pathogenesis was discussed on literature.The patient, 23 years old man, was admitted toour department because of muscular deteriorationof the left extrimities and the sensory disturbanceat the level of C₆-T₁ and L₅-S₂.

Left Horner's symtom, left peripheral facial palsywere noted at the time of hospitalization. Myelo-graphy revealed the compression of the spinal cordfrom the left to the right at the level of C₆-T₁and S₁-₂. There was no abnormality in the peri-pheral blood until 5 days after cervical laminectomywhen peripheral leukocyte count were suddenlyincreased, and immature cells were discovered, andthe patient terminated in the acute myelogenousleukemia in 5 months. Histologically, cervicalepidural tumor was highly cellular neoplastic tissuebeing composed of ill bordered dark cells withnarrow cytoplasm and round or oval, and often in-dented dark nuclei. Fine reticular network wasfound among neoplastic cells on preparation of silverimpregnation. The autopsy revealed marked in-filtration of leukemic cells in the brain and spinalcord, especially in the perivascular and subarachnoidspaces. Bone marrow showed hyperplasia withnumerous leukemic cells. And there were noleukemic infiltration in the nerve roots and duramatter in the spinal region. There were mildpathogenic cell infiltration in lymphnodes, spleen,adrenal glands, lung, testis, and intestinal mucosa.

The possibility of the presence of a common stemcell which might form the malignant lymphomaand myelogenous leukemia was discussed on litera-ture concerning with our case.