頭蓋骨内髄膜腫と肺癌の1重複例

Intraosseous Meningioma Associated with Lung Cancer: A case of multiple neoplasms

I．はじめに

　高齢人口の増加と癌の診断及び治療技術の進歩によって重複腫瘍の症例を経験する機会が増加してきた．しかしながら，重複が確認されるのは剖検手術時や異時性の場合が多い．

　今回われわれは，肺癌患者で術前の転移巣検索時に発見した頭蓋骨病変が頭蓋骨内髄膜腫であった症例を経験したので報告する．

Intraosseous tumor was found in a 63 year old male patient with lung cancer during metastatic work-up study. Plain skull X-ray film showed a large osteolytic le-sion in the left temporo-parietal bone. Bone and Ga scintigrams revealed an increased activity in this lesion. CT scan demonstrated an isodense lentiform configura-tion, which was homogeneously enhanced with contrast medium. It was iso-intense in T1, and high-intense in T2 and proton weighted MR images. The tumor was re-moved en bloc with surrounding nomal bone. The attached dura was markedly thickened, but there was no tumor infiltration. Histological diagnosis was transitional meningioma with psammoma body. Postoperatively he was transferred back to Okinawa Hospital and right lower lobectomy was performed for the lung tumor. Histological diagnosis was well-dif-ferentiated adenocarcinoma. We examined immunohisto-chemically p53 protein expression, but p53 immunoacti-vity was observed in neither tumor.

Multiple neoplasms associated with brain tumor are relatively rare, but the incidence will increase in the fu-ture as the diagnostic work-up develops. Pathological dia-gnosis will give us the decisive opportunity for proper treatment. It is to be stressed that, in multiple neoplasms, care should be taken to avoid misdiagnosis of metastasis.