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Neurological Surgery No Shinkei Geka Volume 48, Issue 7 （July 2020）

Neurological Surgery 脳神経外科 48巻7号（2020年7月発行）

Japanese English

症例

Growing teratoma syndromeを呈した胚細胞性腫瘍の2例 Intracranial Growing Teratoma Syndrome:Case Reports and Literature Review 仙北谷直幹 ¹ , 小田正哉 ¹ , 小野隆裕 ¹ , 高橋和孝 ¹ , 畠山潤也 ¹ , 富樫俊太郎 ¹ , 笹嶋寿郎 ² , 山田正三 ³ , 清水宏明 ¹ Naomoto SENBOKUYA ¹ , Masaya ODA ¹ , Takahiro ONO ¹ , Masataka TAKAHASHI ¹ , Junya HATAKEYAMA ¹ , Syuntaro TOGASHI ¹ , Toshio SASAJIMA ² , Shozo YAMADA ³ , Hiroaki SHIMIZU ¹ ¹秋田大学医学部附属病院脳神経外科 ²秋田県立リハビリテーション・精神医療センター認知症診療部 ³森山脳神経センター病院間脳下垂体センター ¹Department of Neurosurgery, Akita University Hospital ²Department of Dementia, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine ³Department of Neurosurgery, Moriyama Neurological Center Hospital キーワード： germ cell tumors , growing teratoma syndrome Keyword: germ cell tumors , growing teratoma syndrome pp.587-594

発行日 2020年7月10日 Published Date 2020/7/10

DOI https://doi.org/10.11477/mf.1436204236

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　Growing teratoma syndrome（GTS）は，胚細胞性腫瘍に対する化学放射線療法中あるいは療法後に生じる腫瘍の増大で，腫瘍マーカーの上昇を認めず，病理組織学的に成熟奇形腫のみからなるものと定義される^2,7)．化学放射線療法はもはや奏効せず，手術が唯一の治療となるため，そのタイミングも含め慎重かつ確実な判断が必要となるが，必ずしも容易ではない．今回われわれは，GTSを呈した胚細胞性腫瘍の2手術例を経験したので，文献的考察を加えて報告する．

　BACKGROUND：Growing teratoma syndrome（GTS）is the progression of a mature teratoma during or following radiochemotherapy for germ cell tumors. We report two surgical cases of GTS.

　CASE 1：A 24-day-old new-born presented with vomiting and head enlargement. Blood alfa-feto protein（AFP）and beta-human chorionic gonadotropin（β-hCG）were within or at the upper limits of the normal ranges. Magnetic Resonance Imaging（MRI）demonstrated a large mass in the posterior fossa causing the severe hydrocephalus. Tumor removal was immediately performed. Histological diagnosis given was immature teratoma. While chemotherapy effectively reduced the level of tumor makers, multiple recurrence was noticed on MRI 70 days after the surgery. GTS was suspected and total removal was performed. Histological examination revealed a mature teratoma. The patient is growing normally thereafter, 2.5 years after the onset.

　CASE 2：A 16-year-old male presented with binasal hemianopsia. Blood AFP and β-hCG were within or at the upper limits of the normal ranges. MRI demonstrated an intrasellar mass protruding upward. Tumor removal was performed and histological diagnosis given was mixed germ cell tumor. While radiochemotherapy effectively normalized the tumor makers, recurrence was noticed on MRI 190 days after the surgery. Total removal was performed with the diagnosis of GTS. Histological examination revealed a mature teratoma. The patient lives a normal school life thereafter as followed up after a year after the onset.

　CONCLUSION：It is important to diagnose and perform the surgery early enough to enable total removal of the mass presenting as GTS because total surgical removal is the only treatment for GTS.