骨軟部悪性腫瘍診断の遅れ―確定診断まで長期間を要した症例の検討

Delay in the Diagnosis of High-Grade Malignant Bone and Soft Tissue Tumor

　抄録：医療機関受診から3カ月以上を経過して初めて悪性腫瘍と診断された高悪性度骨軟部腫瘍症例について検討した．体幹発生例は炎症性疾患や変性疾患と誤診された症例が多く，四肢発生例では良性腫瘍と誤診された症例が多かった．四肢発生の軟部腫瘍では，浅在性の腫瘍であることが診断の遅れの原因の1つであった．早期診断のためには，四肢発生例では皮下に生じた腫瘍であっても悪性腫瘍の可能性が少なくないこと，一方，体幹発生例では非腫瘍性疾患と思われる症状を呈する症例のなかに悪性腫瘍が含まれている可能性があることを念頭に置いて診療することが重要である．また，組織試験切除の標本が不適切であった症例や，病理診断で良性と診断された症例も認められた．組織試験切除の正確な実施と病理医への十分な情報提供が早期診断には重要である．

　Thirty-two cases of high-grade malignant bone and soft tissue tumors correctly diagnosed more than 3months after the first visit to a medical institution were reviewed. Tumors located in the trunk (trunk type) were often misdiagnosed as inflammatory disease or degenerative disease, while malignant tumors located in the extremities (extremity type) were mostly managed as benign tumors. One reason for the delay in diagnosis was the higher frequency of subcutaneous tumors than deep-seated tumors in the extremity. Early correct diagnosis requires that the possibility of malignancy be considered even when a subcutaneous tumor is the extremity type. The possibility of malignancy should also be considered when the effect of the primary therapy is poor in a patient with a non-tumorous lesion of the trunk. Inaccurate biopsy specimens and incorrect pathological diagnoses were made in some cases. Performing accurate biopsies and providing the pathologist with adequate information are important for early correct diagnosis.