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Neurological Surgery No Shinkei Geka Volume 46, Issue 6 （June 2018）

Neurological Surgery 脳神経外科 46巻6号（2018年6月発行）

Japanese English

症例

悪性転化し，髄腔内播種を来したと思われる類上皮腫の1例 A Case of Malignant Transformation of Epidermoid Cyst with Cerebrospinal Fluid Dissemination 末松裕貴 ¹ , 武石剛 ² , 横上聖貴 ² , 上原久生 ² , 魏峻洸 ³ , 山下篤 ³ , 佐藤勇一郎 ⁴ , 竹島秀雄 ² Yuuki SUEMATSU ¹ , Go TAKEISHI ² , Kiyotaka YOKOGAMI ² , Hisao UEHARA ² , Toshihiro GI ³ , Atsushi YAMASHITA ³ , Yuichiro SATO ⁴ , Hideo TAKESHIMA ² ¹宮崎県立日南病院脳神経外科 ²宮崎大学医学部臨床神経科学講座脳神経外科学分野 ³宮崎大学医学部病理学講座腫瘍・再生病態学分野 ⁴宮崎大学医学部病理診断科・病理部 ¹Department of Neurosurgery, Miyazaki Prefectural Nichinan Hospital ²Divison of Neurosurgery, Department of Clinical Neurology, Faculty of Medicine, University of Miyazaki ³Division of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki ⁴Division of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki キーワード： epidermoid cyst , squamous cell carcinoma , malignant transformation , CSF dissemination Keyword: epidermoid cyst , squamous cell carcinoma , malignant transformation , CSF dissemination pp.509-514

発行日 2018年6月10日 Published Date 2018/6/10

DOI https://doi.org/10.11477/mf.1436203760

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Ⅰ．はじめに

　類上皮腫は脳腫瘍の中で0.2〜1.8%を占める良性腫瘍である³⁾．組織学的には角化を伴う重層扁平上皮で被覆された囊胞であり，皮膚付属器は伴わない．好発部位としては小脳橋角部，中頭蓋窩，トルコ鞍近傍，脊髄，頭蓋骨板間層などがあり，稀に悪性転化して扁平上皮癌が発生する³⁾．今回われわれは，悪性転化し，髄腔内播種を来したと思われる類上皮腫の稀な1例を経験したため，文献的考察を含めて報告する．

　An epidermoid cyst is a benign tumor, accounting for 0.2-1.8% of all brain tumors. Histologically, an epidermoid cyst has a wall consisting of squamous epithelium with keratinization and without skin components. An epidermoid cyst tends to develop in the cerebellopontine angle（CPA), middle cranial fossa, pituitary fossa, spinal cord, and other locations. We describe a rare case of malignant transformation of an epidermoid cyst with cerebrospinal fluid（CSF）dissemination.

　A 54-year-old man was referred to our hospital with chief complaints of dysesthesia of the right leg, persisting for 6 months, and dizziness and dysarthria for 2 months. Magnetic resonance（MR）imaging showed multiple neoplastic lesions with lobulated margins in the left frontal and temporal lobes, left cerebellum, right brainstem, and right CPA. Diffusion-weighted imaging showed a hyperintense cord-like lesion in the right CPA. Blood examination revealed squamous cell carcinoma（SCC）antigen positivity;however, systemic examination revealed no neoplastic lesion, except for the head lesion. Intracranial lesions were considered unlikely to be metastatic brain tumors. We performed surgical removal of the tumor in the left CPA via a left lateral suboccipital craniotomy. The histopathological diagnosis was SCC.

　MR imaging for the headache was taken at another hospital 2 years before the surgery, revealed an epidermoid cyst in the right CPA. The current MR imaging showed enhancement in part of the epidermoid cyst in the right CPA, strongly suggesting that the epidermoid cyst in the right CPA had disseminated to the left frontal and temporal lobes, left cerebellum, and right brainstem via the CSF.