睾丸Seminomaが頭蓋及び頭蓋内へ転移した1例

A Case of Cranial and Intracranial Metastasis from Testicular Seminoma

I．はじめに

　睾丸のgerm cell tumorが頭蓋及び頭蓋内へ転移をすることは珍しく，全転移性脳腫瘍中0.7％を占めるにすぎない．中でもseminomaは，睾丸腫瘍の5％を占めるにすぎないのでこれが頭蓋及び頭蓋内に転移するのは非常に稀なこと^9）と考えられる．われわれは，睾丸に原発したseminomaが3年後，頭蓋及び頭蓋内に転移した症例を経験したのでその診断と治療経過について報告する．

The case presented is of a 44-year-old man with skull and intracranial metastasis of seminoma. He was oper-ated on for a testicular tumor at 41 years of age. Patho-logically, it was pure seminoma. Coronal CT scan showed tumor invasion of the subcutaneous vault, and of the epidural and intraparenchymal region of the right parietal region. We treated him with a combina-tion of surgical excision, radiation and PVB chemother-apy. He was neurologically disease-free for ten months after being discharged. However, he then succumbed to liver metastasis of seminoma. Seminoma mainly meta-stasizes via the lymph stream. CNS metastasis of semi-noma is only 0.7% in Japan. We would like to stress that prophylactic chemotherapy would be essential even after patients get remission from CNS metastasis of seminoma.