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はじめに
軟部組織に原発する髄外性形質細胞腫は比較的まれな腫瘍であるが,頭頸部領域,特に鼻副鼻腔を含む上気道に原発することが多い。その治療には従来,手術,放射線あるいは両者の併用などが主として行われてきたが,局所のコントロールができれば予後は比較的良好であるといわれている1〜3)。しかしながら,形質細胞腫は,元来血液疾患の1つで,再発例や多発性骨髄腫へ移行した例も少なからず報告されており,その予後については必ずしも予断を許さない一側面をもっている4〜6)。
今回われわれは,M蛋白を認めず,鼻副鼻腔領域に孤立性髄外性形質細胞腫として発症しながら,比較的急速に全身転移をきたした髄外性形質細胞腫の1例を経験したので,文献的考察を加えて報告する。
A 93-year-old male presented with a bulky exten-sive tumor occupied in the left maxillary antrum with bony invasion including the orbital floor. The tumor was histologically diagnosed as extramedui-lary plasmacytoma.
Irradiation therapy was employed as the primary treatment of choice because of his advanced age and locally extensive disease, but the tumor was radio-resistant and developed metastatic spread to the bilateral parotid glands and abdominal wall without systemic myelomatous lesions.
The patient received combination chemotherapy by melphalan and prednisolone (M-P) for dis-seminated disease with good response, which was later confirmed by postmortem examinations.
We emphasize that combination chemotherapy should be added as another modality of treatment for this disease to surgery and radiation, either alone or in combination.
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