脳室内出血にて発症した松果体部glioblastoma multiformeの1例

A Case of Glioblastoma Multiforme in the Pineal Region with Intraventricular Hemorrhage

Ⅰ．はじめに

　松果体部腫瘍は成人の全脳腫瘍の0.4%の頻度と報告されており³⁾，組織型の内訳としてはgerm cell tumorが50～75%，松果体部実質腫瘍が15～27%とされるが，gliomaに関しての報告は少ない．Glioblastoma multiforme（GBM）は一般的に最も頻度が高い悪性脳腫瘍であるが，松果体部では比較的稀で，過去に18例が報告されているのみであり，予後は極めて悪いとされる^{1,2,4-9,11-15)}．

　松果体部腫瘍による初発症状の多くは頭蓋内圧亢進症状，眼球運動障害などと報告されており，現在までに腫瘍内出血で発症したものとして，choriocarcinoma，meningioma，cavernous angioma，pineoblastomaなどが報告されているが，gliomaの報告はない．今回われわれは脳室内出血にて発症した松果体部GBMの1例を経験したので，その診断から治療について報告する．

　Introduction:Glioblastoma multiforme（GBM）is a very rare type of tumor involving the pineal region. No case of pineal region GBM with tumoral hemorrhage has ever been reported. Here, we present the first such case report.

　Case report:A 65-year-old man presented with sudden-onset disturbance of consciousness. CT revealed intraventricular hemorrhage and acute hydrocephalus. The patient was treated by an emergent operation for ventricular drainage. MRI with contrast media showed a heterogeneous enhanced area in the pineal region. The patient underwent endoscopic biopsy surgery and a third ventriculostomy for non-communicating hydrocephalus. The pathological diagnosis was high-grade glioma, indicating the need for tumor removal via the occipital transtentorial approach. The tumor was removed subtotally and radiation and chemotherapy courses were then started.

　Conclusion:Pineal GBM with tumoral hemorrhage has never been reported before. Endoscopic operations are useful for rapid decision making prior to radical surgery.