髄内髄外に発生した脊髄血管芽腫の1例

Intramedullary Hemangioblastoma with Extramedullary Exophytic Growth

　硬膜内髄外腫瘍と術前診断したが，実際には髄内から髄外に進展した脊髄血管芽腫の1例を経験した．症例は43歳の男性．主訴は腰背部痛．理学所見は下肢深部腱反射が亢進していたが，筋力・知覚は正常であった．MRI T2強調像でTH9・10硬膜内右側に高信号を示す腫瘍が見られ，カドリニウムで均一に増強された．脊髄造影後CTで脊髄と個別に腫瘍が右側に偏在していた．画像所見から硬膜内髄外腫瘍と診断し手術を行ったが，実際には髄内に腫瘍が存在し髄外に進展していた．病理所見でstromal cellが観察され，血管芽腫と診断した．

　We report a case of intramedullary hemangioblastoma with extramedullary exophytic growth. The patient was a 43-year-old man whose only symptom was low back pain. Physical examinations revealed increased deep tendon reflexes in both lower extremites, but there was no leg weakness or sensory loss. Magnetic resonance imaging (MRI) revealed an intradural lesion located at Th9 and Th10 that was high intensity on the T2-weighted images. Gadolinium strongly and homogeneously enhanced the tumor. Computed tomography myelography showed that the tumor was located on the right side of the spinal cord. The lesion was presumed to be extramedullary, but it was actually intramedullary with extramedullary exophytic growth. Histologic examination confirmed the diagnosis of hemangioblastoma because of the presence of stromal cells.