骨髄異形成症候群に胸椎部脊髄腫瘍を生じた1例

Thoracic Spinal Cord Tumor with Myelodysplastic Syndrome. Case Report

　46歳，女性．腰痛，両下肢しびれ感を主訴に受診した近医で，胸髄部腫瘍と著しい汎血球減少を指摘された．両下肢痛と歩行障害が進行し，骨髄異形成症候群の治療も含め，当院へ紹介された．両下肢麻痺が進行し，さらに尿閉が出現したため，輸血で血球数を増加させ，腫瘍摘出術に踏み切った．術後はHLA適合血小板輸血とG-CSF投与を行った．神経症状はほぼ回復した．骨髄異形成症候群は外科的治療の大きな障壁となりうる．手術時には血液内科医との連携が必要で，今回は術後合併症を認めず，麻痺のほぼ完全回復が得られた．

　This case was a 46-year-old female who had muscle weakness and numbness of the bilateral lower extremities. A thoracic intradural extramedullary tumor and pancytopenia had been found at a nearby clinic. Pain of the bilateral lower extremities and gait disturbance progressed. Therefore, she was referred to our hospital for treatment of myelodysplastic syndrome. Paralysis of the bilateral lower extremities progressed and ischuria eventually developed. Therefore the number of blood cells increased with blood transfusion and we carried out an enucleation. After the operation, we controlled pancytopenia with blood transfusion of HLA matched platelets and the use of G-CSF. Finally, the neurogenic symptoms almost resolved. Myelodysplastic syndrome can make operating surgically impossible. At the time of surgical operation, it is necessary to cooperate with the hematologist for temporarily improve pancytopenia. In this case, fortunately, the paralysis was almost completely reversed with no complications after the operation.