原発不明で脊椎転移を来した印環細胞癌の2例

Spinal Metastasis by a Signet-ring Cell Carcinoma of Unknown Origin. Report of Two Cases

　原発不明癌で脊椎転移を生じた印環細胞癌の2症例を経験した．2症例とも術前のCT，18F-FDG-PETなどの各種検査で原発巣は特定できず，経過中に急速に進行する麻痺症状が出現したため，緊急手術を行った．術後2症例とも麻痺症状の改善を認め，ADLの向上が得られた．また転移椎体組織の病理学的検査で2症例ともに印環細胞癌の確定診断が得られ，1例で原発巣が胃であることを特定でき，その後の治療方針の決定に非常に有用であった．

　We report two cases of spinal metastasis by a signet-ring cell carcinoma of unknown origin.　Detailed examinations by CT and 18F-FDG-PET failed to detect the primary tumor in either case.　Because of rapidly progressive bilateral lower limb paralysis, emergency surgery was performed in both patients, and their neurological status improved postoperatively.　The pathological findings in the vertebral body suggested metastasis by a signet-ring cell carcinoma.　In one of the two cases, the stomach was identified as the site of the primary tumor.　One of the patients died of multiple organ failure secondary to the original disease；the other patient received adequate multimodal treatment and is alive.