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Neurological Surgery No Shinkei Geka Volume 20, Issue 4 （April 1992）

Neurological Surgery 脳神経外科 20巻4号（1992年4月発行）

Japanese English

症例

下垂体腺腫の放射線治療14年後に発生したAnaplastic Astrocytomaの1例 Anaplastic Astrocytoma 14 Years after Radiotherapy for Pituitary Adenoma 田村勝 ¹ , 三隅修三 ¹ , 黒崎修平 ¹ , 柴崎尚 ¹ , 大江千広 ¹ Masaru TAMURA ¹ , Syuuzou MISUMI ¹ , Syuuhei KUROSAKI ¹ , Takashi SHIBASAKI ¹ , Chihiro OHYE ¹ ¹群馬大学医学部脳神経外科 ¹Department of Neurosurgery, Gunma University School of Medicine キーワード： Acromegaly , Radiation-induced neoplasm , Malignant glioma , Brain tumor , Radionecrosis Keyword: Acromegaly , Radiation-induced neoplasm , Malignant glioma , Brain tumor , Radionecrosis pp.493-497

発行日 1992年4月10日 Published Date 1992/4/10

DOI https://doi.org/10.11477/mf.1436900451

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Abstract 文献概要
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I．はじめに

　頭部の放射線治療の後に，稀に二次的に脳腫瘍が発生する．髄膜腫，神経膠腫，肉腫の発生頻度がたかく^5），近年増加傾向にある．Salvatiら^11）によると神経膠腫はこれまでに76例報告されており，小児白血病に対し，予防的に全頭部照射を行った後の発生がもっとも多く，次いでトルコ鞍部腫瘍，髄芽腫，頭部白癬に対する照射療法後の順となっている．

　われわれは下垂体腺腫術後の照射療法14年後に側頭葉にanaplastic astrocytomaが発生した1例を報告する．また下垂体腺腫に対する放射線療法後，側頭葉などに遅発性放射線障害を認めることがあり^2），腫瘍発生との関連についても言及したい．

A case of anaplastic astrocytoma following radiother-apy for growth hormone secreting pituitary adenoma is presented with a review of the literature.

A 43 year old female was admitted with the signs of acromegaly and hypertension. An eosinophilic pituitary adenoma was subtotally removed by transsphenoidal approach, and followed by 60 Gy irradiation using a 2 × 2cm lateral opposed field. Fourteen years later atthe age of 57, she suffered from headache, recent-memory disturbance and uncinate fits. CT scan and MRI disclosed ring-like enhanced mass lesion in the left temporal lobe, corresponding to the previous irradi-ated field. ¹⁸F-FDG PET showed hypermetabolism at the lesion. Left frontotemporal craniotomy was per-formed, and a reddish gray gelatinous tumor containing necrotic center and cyst was partially removed. Histolo-gically, the tumor consisted of hypercellular astrocytic cells with perivascular pseudorosette. Coagulation nec-rosis at the center of the tumor, and hyalinosis and fib-rosis of the blood vessels in and around the tumor, which might have been caused by the antecedent radiotherapy, were recognized. Postoperative radio- and chemotherapy were given, however, she expired 13 months after the operation. Seven cases, including ours, of malignant glioma following radiotherapy for pituit-ary adenoma were reported in the literature. A total dose of irradiation varies from 45 to 95 Gy with a mean of 50 Gy. The period of latency before tumor occur-rence ranges from 5 to 22 years with a mean of 10 years. The differentiation of radiation-induced gliomas from radionecrosis of the brain is also discussed.