内頸動脈海綿静脈洞瘻を呈した頭蓋内原発絨毛癌の1例

A Case of Primary Intracranial Choriocarcinoma with a Carotid-cavernous Fistula

I．はじめに

　頭蓋内原発のchoriocarcinomaは稀である．今回われわれは，視交叉部に原発し，carotid-cavernous fistulaを呈したchoriocarcinomaの1例を経験したので報告する．

A 14-year-old Japanese girl was admitted to Kosei General Hospital on May 28, 1987 because of disturbance of visual acuity, bitemporal hemianopsia and general fatigue. About two months before, she had noticed dis-turbance of visual acuity and headache. The CT scans demonstrated iso density mass in the chiasmatic region with ring enhancement. Bilateral carotid angiograms showed bilateral carotid-cavernous fistulas.

The serum HCG rose to 13000mIU/m/ (HCG-β, 480ng/ml) whereas the urinal level was 2200mIU/ml and alpha-feto protein was normal. A diagnosis of cho-riocarcinoma was made. Radiation therapy and combined chemotherapy (cisplatinum, vinblastine, bleomycine) were begun. But radiation and chemotherapy had little effect.

On June 12, 1987, chest X-ray film showed several abnormal shadows in both lungs, and her general condi-tion continued to deteriorate. She died on June 21, 1987. Histologic examination of the tumor disclosed cyto-trophoblastic cells and syncitiotrophoblastic cells with ex-tensive hemorrhage and necrosis. Extracranial metasta-sis was found only in both lungs.