好酸球性肉芽腫が疑われた小児頚椎破壊性病変の1例

Destructive Lesion in the Cervical Spine of a Child in Whom Eosinophilic Granuloma Was Suspected. Case Report

　4歳，男児の第5頚椎に発生した頚椎破壊性病変の1例を報告する．患児は頚部痛で発症し，その後両前腕痛を訴えた．両側下肢腱反射は亢進していた．単純X線像で第5頚椎椎体の圧潰を認めた．MRIで同椎体の圧潰および，第3頚椎～第7頚椎レベルの脊柱管内に脊髄を前方から圧排する腫瘤を認めた．好酸球性肉芽腫を疑い，生検を行った．病理組織像では好酸球性肉芽腫の典型像は得られなかったが悪性疾患は否定された．治療としてハローベスト固定による保存療法を施行した．自覚症状は早期より消失し，良好な臨床経過を得た．

　We report the case of 4-year-old boy in whom vertebra plana of C5 was demonstrated radiographically. He first complained of neck pain, and then developed pain in both forearms. Physical examination revealed increased deep tendon reflexes in both lower extremities. MRI revealed a mass lesion from C3 to C7 that had expanded into the epidural space and compressed the spinal cord. These findings suggested that the lesion was an eosinophilic granuloma. An open biopsy was performed, but the histological findings were not typical of eosinophilic grancloma. Malignant disease, howerer, was ruled out. We treated the patient conservatively with a halo vest, and his symptoms were immediately relieved.