短期間に増大する頭部皮下腫瘤を契機に診断されたhemangiopericytomaの1手術例

Intracranial Osteolytic Hemangiopericytoma Manifesting as a Rapidly Enlarging Extracranial Soft Tissue Mass Lesion

Ⅰ．はじめに

　Hemangiopericytomaは静脈洞近傍に発生し，静脈洞閉塞に起因する頭蓋内圧亢進症状や発生部位に応じた局所症状を契機に診断されることが多い^1,4)．また，再発や遠隔転移を生じ，悪性な経過を辿る可能性があり^5,6)，早期の診断および治療が必要な疾患と考えられる．今回，短期間で急速に増大した無痛性・無症候性の頭部皮下腫瘤を契機に診断されたhemangiopericytomaの1手術例を経験したので報告する．

　Hemangiopericytoma is a highly vascular and rapidly growing tumor, which tends to recur at distant locations. Complete surgical resection is often difficult because of intraoperative excessive hemorrhage or brain swelling.

　A 31-year-old male presented with intracranial osteolytic hemangiopericytoma manifesting as a rapidly enlarging extracranial soft tissue mass lesion causing a subcutaneous mass in the forehead. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a lesion in the frontal lobe. Careful follow up was performed because the patient suffered no neurological deficits. The subcutaneous mass rapidly enlarged for 6 months. CT and MR imaging showed an osteolytic intracalvarial lesion with an extradural soft tissue component. Angiography demonstrated obstruction of the superior sagittal sinus and dense tumor staining with slow circulation and venous drainage. Gross total surgical resection was performed following endovascular embolization of the feeding arteries. Histological examination demonstrated an hemangiopericytoma.

　Although rare, hemangiopericytoma should be included in the differential diagnosis of rapidly enlarging subcutaneous mass. Preoperative endovascular treatment may allow less invasive surgery.