前額部腫瘤を呈した頭蓋骨悪性リンパ腫の1例

Primary Malignant Lymphoma of the Skull Presenting as a Growing Mass in the Forehead:A case report

I．はじめに

　悪性リンパ腫のうち，骨原発のものはホジキンリンパ腫ではきわめて稀であり，非ホジキンリンパ腫でも4％前後^3,13-16）と報告されている．またその発生部位についてみても，椎体・骨盤骨・肋骨・長管骨が好発部位であり，頭蓋骨は極めて稀である^13-17）．今回われわれは，外傷を契機として，前額部皮下腫瘤で発症した頭蓋骨悪性リンパ腫の1例を経験したので，若干の文献的考察を加えて報告する．

Abstract

A rare case of primary malignant lymphoma of the skull was reported.

A 79-year-old woman was admitted to our hospital comlaining of a growing mass in her forehead where she had had minor trauma one month previously. On admission, neurological findings were normal and an elastic hard tumor (6 × 6 × 2cm) was found in the right frontal region. Computed tomography (CT) showed a large soft tissue mass in the subcutaneous tis-sue and a small mass in the ethmoid sinus, with erosion at the inner and outer tables of the frontal bone.Magnetic resonance imaging revealed a low intensity area in the bone marrow beneath the tumor. Right carotid angiography showed that the tumor was fed by branches of the ophthalmic artery in the arterial phase and stained in the capillary phase.

Partial excision of the tumor was performed, but the affected bone was left because of her advanced age, even though thinning and spicular formation of the frontal bone were observed beneath the tumor in places. Pathological examination showed the tumor to be a malignant lymphoma of non-Hodgkin and diffuse mixed type.

Postoperatively, systemic examinations were per-formed by 99m Technetium-MDP bone scanning, 67Gal-lium citrate scanning, bone marrow puncture, and CT scanning, without any evidence of systemic lymphoma. The patient received postoperative chemotherapy with Cyclophosphamide, Doxorubicin HCI, Vindesine Sulfate, Predonisolone, and complete remission has been achieved for the 8 months since the operation.