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Neurological Surgery No Shinkei Geka Volume 48, Issue 2 （February 2020）

Neurological Surgery 脳神経外科 48巻2号（2020年2月発行）

Japanese English

症例

再発high-grade astroblastomaに対する定位放射線治療—症例報告 Recurrent High-grade Astroblastoma Treated with Stereotactic Radiotherapy:A Case Report 樋口眞也 ^1,2 , 川西裕 ^1,3 , 近藤雄一郎 ^1,2 , 中居永一 ¹ , 福田仁 ¹ , 福井直樹 ¹ , 中城登仁 ^1,3 , 小林加奈 ⁴ , 村上一郎 ⁵ , 上羽哲也 ¹ Shinya HIGUCHI ^1,2 , Yu KAWANISHI ^1,3 , Yuichiro KONDO ^1,2 , Eiichi NAKAI ¹ , Hitoshi FUKUDA ¹ , Naoki FUKUI ¹ , Takahito NAKAJO ^1,3 , Kana KOBAYASHI ⁴ , Ichiro MURAKAMI ⁵ , Tetsuya UEBA ¹ ¹高知大学医学部脳神経外科 ²近森病院脳神経外科 ³高知県立あき総合病院脳神経外科 ⁴高知大学医学部放射線科 ⁵高知大学医学部附属病院病理診断部 ¹Department of Neurosurgery, Kochi Medical School ²Department of Neurosurgery, Chikamori Hospital ³Department of Neurosurgery, Aki General Hospital ⁴Department of Radiology, Kochi Medical School ⁵Laboratory of Diagnostic Pathology, Kochi Medical School Hospital キーワード： astroblastoma , ¹¹C-methionine positron emission tomography , stereotactic radiotherapy Keyword: astroblastoma , ¹¹C-methionine positron emission tomography , stereotactic radiotherapy pp.151-158

発行日 2020年2月10日 Published Date 2020/2/10

DOI https://doi.org/10.11477/mf.1436204152

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Ⅰ．はじめに

　Astroblastomaは神経膠腫の0.45〜2.8%で発生する稀少な脳腫瘍であり，小児から若年成人の大脳半球に好発する¹¹⁾．手術での摘出率が再発や予後に関与することは示唆されているが，術後の補助療法や再発時の治療方針は確立されていない．今回われわれは，定位放射線治療（stereotactic radiotherapy：SRT）が有効であった再発high-grade astroblastoma症例を経験したので報告する．

　INTRODUCTION：Astroblastoma is a rare, supratentorial glial tumor, occurring predominantly in children and young adults. However, treatment strategies have not yet been established for this rare disease.

　CASE PRESENTATION：A 6-year-old boy presented with headache and nausea. CT and MRI revealed a left frontal mass lesion with slight edema and macrocalcifications. Gross tumor resection was performed. Histological examination found neoplastic cells with astroblastic characteristics, and a striking perivascular array of pseudorosettes. The final diagnosis was high-grade astroblastoma. MRI 13 months after surgery suggested local recurrence, and an enlargement was found 3 months later. Stereotactic radiotherapy（SRT）was performed. MRI after SRT showed enhanced cyst formation around the tumor bed, suggesting tumor recurrence. However, ¹¹C-methionine positron emission tomography（PET）revealed radiation necrosis. The last follow-up MRI 15 months after SRT showed no further recurrence.

　CONCLUSION：Astroblastoma is rare, therefore, no optimal management is known. SRT may be effective to treat recurrent astroblastomas. ¹¹C-methionine PET/CT was useful to differentiate metastatic disease from radiation necrosis.