脳内転移をきたした末梢神経由来悪性神経鞘腫の1例

Metastatic Intracerebral Malignant Schwannoma Derived from Peripheal Nerve, Care report

I．はじめに

　悪性神経鞘腫（malignant schwannoma）は，末梢神経に生じ，von Recklinghausen病に伴い易い比較的稀な腫瘍である．脳内転移を来すことはきわめて稀であり，渉猟し得た範囲では数例が報告されているのみである．今回脳内転移をきたした末梢神経由来の悪性神経鞘腫の1例を経験したので，若干の文献的考察を加え報告する．

A 53 year old male complaining of headache and left hemiparesis was referred to our hospital on November 11,'89. He had no evidence of von Recklinghausen's disease. He had been operated on because of a well cir-cumscribed tumor in the left paravertebral muscle on July 11,'87, and metastasis in the lower lobe of the left lung on April 20,'88. The pathological diagnosis of both the primary and the metastatic lung tumor was malignant peripheral nerve sheath tumor showing peripheral cell differentiation (malignant schwannoma).

Contrast enhanced CT demonstrated an irregularly enhanced mass in the right parietal lobe just before admission. On the night of admission November 12, '89, he suddenly had severe headache and this progressed to hemiparesis. Repeat CT examination was done im-mediately and revealed intratumoral hemorrhage. On November 19,'89, the tumor was totally removed. His symptoms disappeared postoperatively. The pathologic-al findings of the tumor were the same as those made previously.

The patient received radiotherapy to the brain (local 50 Gy and whole brain 30 Gy) and chemotherapy with nitrosourea (MCNU 150mg). He was discharged with-out neurological deficits. However he had two opera-tions to remove metastatic tumors in the soft tissue of the hip on January 12, and August 17,'90.

A very rare case of metastatic intracerebral malig-nant schwannoma is reported, and the literature on this point is reviewed.