Convexity meningioma様の画像所見を呈した頭蓋内限局型Castleman病の1症例

A Case of Intracranial Localized Castleman's Disease Mimicking Convexity Meningioma

Ⅰ．はじめに

　Castleman's disease（CD）は，脳神経外科領域においては馴染みのない血液疾患の1つである．比較的稀で，単発あるいは多発性のリンパ節腫大を呈する原因不明のリンパ増殖性疾患であり，臨床的には孤発性病変を形成する限局型（localized type）と，全身のリンパ節腫大などさまざまな全身症状を伴った多発型（generalized type）に大別される¹⁾．頭蓋内浸潤は極めて稀である．組織学的には，比較的予後良好なhyaline-vascular typeと，全身性の症状を有しmalignancyの様相を呈するplasma cell typeに分けられる^1,8,12)．

　今回われわれは，術前画像診断および術中所見にて円蓋部髄膜腫と考えられた限局型CDの極めて稀な1症例を経験したので，文献的考察を加え報告する．

　A 68-year-old man presented with abnormal behavior and Todd's paralysis on the right side after having taken a bath. Computed tomography and magnetic resonance imaging revealed a tumor mimicking convexity meningioma that had a perifocal edema, although its mass was not very large. The patient underwent surgery, and full recovery was achieved following a total removal of the lesion. Pathohistological examination demonstrated an intermediate type of Castleman's disease. The final diagnosis was intracranial localized Castleman's disease because the results of the full physical examination and laboratory analyses were normal.

　Castleman's disease is a rare lymphoproliferative disorder of unknown etiology. Moreover, intracranial involvement is very rare. In cases of intracranial meningeal tumors with perifocal edema, we should take this disease into consideration in the differential diagnosis.