悪性脳腫瘍に類似した所見を呈した多発性硬化症の1小児例

A Pediatric Case of Multiple Sclerosis Mimicking Malignant Brain Tumor

Ⅰ．はじめに

　われわれは，脳実質内に著明な周辺浮腫と圧排効果を伴う占拠性病変を来し，悪性脳腫瘍に非常に類似する所見を呈した多発性硬化症の小児例を経験したので若干の文献的考察を加え報告する．

We report a pediatric case of multiple sclerosis mimicking malignant brain tumor. A 11-year-old male presented with high fever,vomiting and partial convulsion of left lower extremity followed by left visual impairment. Magnetic resonance imaging (MRI) revealed a mass lesion in the right frontal lobe with significant peripheral edema. Incomplete ring-like enhancement by gadolinium administration was also noted. Open biopsy of the lesion was undertaken that provided pathological confirmation of demyelinating changes. Luxol fast blue stain and Bodian stain demonstrated extensive myelin loss and good preservation of axons. The patient was given intravenous high-dose methylprednisolone and sequential oral low-dose prednisone,which improved his neurological status progressively. The lesion was dramatically decreased in size and finally disappeared. Although many tumor-like demyelinating lesions were reported previously,pediatric cases of multiple sclerosis mimicking malignant brain tumor are extremely rare. Pathological examinations including Luxol fast blue stain and Bodian stain are essential for exact diagnosis.