初回治療から7年後に脊椎転移を来した大腿軟部巨細胞腫の1例

Giant Cell Tumor of Soft Tissue Arising in the Thigh with Spinal Metastasis at 7 Years after Initial Treatment. Case Report

　症例は74歳の女性で，右大腿軟部腫瘍で初診した．生検後，広範切除と術後照射を施行した．患者はこの2年前に他院で肺腫瘍の切除術を受け，組織診断が巨細胞腫であった．大腿軟部病変は術後，局所再発は認めなかったが，7年後に第11胸椎に骨転移を生じ，第11胸椎全摘術を施行した．組織学的所見では悪性変化は認められなかった．しかし，術後全身多発転移で急性増悪し，全経過10年4カ月で腫瘍死した．肺以外への遠隔転移を呈したこと，肺病変の治療が先行したこと，軟部原発，骨原発両者の異次多発の可能性も否定できず，極めて稀な臨床経過を呈した1例を報告する．

　We report a rare case of giant cell tumor of soft tissue with an aggressive clinical course.　A 74-year-old woman noticed a mass on the posterior aspect of her right thigh.　We performed wide excision of the tumor and postoperative radiotherapy.　Two years before, a lung tumor had been resected at the another hospital, and the histological diagnosis was giant cell tumor.　There was no evidence of local recurrence, but 7 years after previous surgery, a bone metastasis was diagnosed in the 11th thoracic vertebra.　We treated it by total spondylectomy and reconstruction.

　The histological findings were similar to those of the previous thigh lesion, but postoperatively her clinical condition rapidly deteriorated, and multiple bone metastases and intra-abdominal dissemination were detected.　The patient died 10 years 4 months after the initial diagnosis.　The preceding of the lung tumor and the possibility of multicentric tumorigenesis in the lung and extraosseous and osseous lesions were unclear.