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Neurological Surgery No Shinkei Geka Volume 20, Issue 1 （January 1992）

Neurological Surgery 脳神経外科 20巻1号（1992年1月発行）

Japanese English

症例

眼窩内Benign Mixed Tumorから19年後にSquamous Cell Carcinomaに悪性転化した1例 Malignant Transformation of Benign Mixed Tumor of Lacrimal Gland to Squamous Cell Carcinoma Nineteen Years after Initial Surgery:Report of a case. 亀井一郎 ¹ , 吉田夏彦 ¹ , 湯川修也 ¹ , 藪本充雄 ¹ , 岩本宗久 ¹ , 栗山剛 ¹ , 横山道明 ² , 静木厚三 ³ Ichiro KAMEI ¹ , Natsuhiko YOSHIDA ¹ , Shuya YUKAWA ¹ , Michio YABUMOTO ¹ , Munehisa IWAMOTO ¹ , Tsuyoshi KURIYAMA ¹ , Michiaki YOKOYAMA ² , Kohzo SHIZUKI ³ ¹和歌山赤十字病院脳神経外科 ²和歌山赤十字病院耳鼻咽喉科 ³和歌山赤十字病院病理 ¹Department of Neurosurgery, Wakayama Red Cross Hospital ²Department of Otorhinolaryngology, Wakayama Red Cross Hospital ³Department of Pathology, Wakayama Red Cross Hospital キーワード： Benign mixed tumor , Malignant transformation , Squamous cell carcinoma , Orbit Keyword: Benign mixed tumor , Malignant transformation , Squamous cell carcinoma , Orbit pp.79-83

発行日 1992年1月10日 Published Date 1992/1/10

DOI https://doi.org/10.11477/mf.1436900388

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Abstract 文献概要
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I．はじめに

　涙腺に発生したbenign mixed tumor（以下，BMTと略す）が時を経て悪性化する場合があることは知られている．しかし，その場合大部分はadenocarcinomaに転化し，squamous cell carcinomaに転化することは極めて稀である．今回，初回摘出より19年後にsquamouscell carcinomaに悪性転化して頭蓋内に大きく進展し，さらに両肺に多発性に転移した眼窩内BMTの1例を経験したので報告する．

A case of malignant transformation of benign mixed tumor (pleomorphic adenoma) arising from the right lacrimal gland is reported. A 63-year-old man was refer. red to our clinic because of visual disturbance and protrusion of the right eye in January, 1989. His past history revealed that he had had a benign mixed tumor of the right lacrimal gland resected 19 years ago.

On CT scan, an iso-density lesion homogeneously en-hanced with contrast medium was found in the right orbit. This tumor was partially cystic and invaded the cranial cavity. On T1 and T2 weighted MRI, the tumor appeared as an iso-intensity area. At surgery, the tumor was subtotally resected via the combined fronto-orbital approach on February 3, 1990. Histological diagnosis of the tumor was squamous cell carcinoma, and it was construed to be a malignant transformation of mixed tumor of the lacrimal gland. Postoperatively he was placed on a course of external radiation therapy (63 Gy in total) in combination with intra-carotid Cisplatin in-jection therapy.

The first sign of the recurrence was seen as multiple metastatic lesions in both lungs about 4 months after the surgery. In December, 1990, protrusion of the left eye and disturbance of ocular movement became pro-gressively worse. On CT scan, recurrent metastatic tumor was seen in the left orbit and paranasal sinuses. Although additional chemotherapy and irradiation brought about a short period of symptomatic relief he succumbed to pneumonia in april 18, 1990. Metastatic squamous cell carcinoma was confirmed in the lung at autopsy.

Review of the literature shows that in most of the malignant mixed tumors, arising from the lacrimal gland, the epithelial component is adenocarcinoma. A quarter of them have adenoid cystic carcinoma, while squamous cell carcinoma is very rare. The prognosis of malignant mixed tumor of the lacrimal gland is very poor because of their early dissemination via lympha-tics and blood vessels ultimately to the lung. The incidence, clinical course and therapy of mixed tumors of the lacrimal gland were discussed.