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Neurological Surgery No Shinkei Geka Volume 22, Issue 10 （October 1994）

Neurological Surgery 脳神経外科 22巻10号（1994年10月発行）

Japanese English

症例

脳腫瘍との鑑別が困難であった外傷性肉芽腫様病変の1症例 A Case of an Intracerebral Mass Lesion Consisting of Traumatic Granulation Tissue 鰐渕昌彦 ¹ , 上出廷治 ^1,3 , 石黒雅敬 ¹ , 帯刀光史 ¹ , 黒川泰任 ¹ , 吉田豊 ² Masahiko WANIBUCHI ¹ , Teiji UEDE ^1,3 , Masanori ISHIGURO ¹ , Koshi TATEWAKI ¹ , Yasutaka KUROKAWA ¹ , Yutaka YOSHIDA ² ¹市立釧路総合病院脳神経外科 ²市立釧路総合病院病理 ³札幌医科大学医学部附属病院脳神経外科 ¹Department of Neurosurgery, Kushiro City General Hospital ²Division of Pathology, Kushiro City General Hospital キーワード： Brain edema , Brain neoplasms , Granulation tissue , Trauma Keyword: Brain edema , Brain neoplasms , Granulation tissue , Trauma pp.963-966

発行日 1994年10月10日 Published Date 1994/10/10

DOI https://doi.org/10.11477/mf.1436900920

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Abstract 文献概要
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I．はじめに

　外傷による脳挫傷の際には脱落した神経細胞に代わり反応性のグリオーシスが起こることが多い．しかし，挫滅が高度の場合には，グリア細胞自体も傷害され，これに代って血管外膜由来の間葉系組織が増生し，ミクログリアあるいは血管由来のマクロファージ，炎症細胞浸潤を伴い肉芽組織を形成し，最終的には瘢痕組織となることが知られている^3）．しかし，治癒過程のこうした肉芽組織が，炎症性あるいは異物性肉芽腫様に，周辺脳浮腫を伴った腫瘤を形成したとの報告はない．

　今回，外傷による出血を混じた挫傷巣が，その治癒過程において周辺脳浮腫を伴い，肉芽組織からなる腫瘤を形成したと考えられる症例を経験し，脳腫瘍との鑑別に苦慮した．その放射線学的特徴とともに病理組織学的所見を報告する．

We reported a rare case of an intracerebral granulo-matous lesion accompanying severe edema formation in the healing stage of traumatic brain contusions.

A 44-year-old male patient came to our outpatient cli-nic due to progressing headache and nausea. Upon computed tomographic examination, a low density mass with strong surrounding edema was detected at the right frontal base. Magnetic resonance images revealed a high intensity mass on both T1- and T2-weighted im-ages at the right frontal base. Upon intravenous injec-tion of a contrast agent, this lesion exhibited multifocal marginal contrast enhancement. Two additional small enhanced mass lesions were detected at the tip of the right temporal lobe and the medial portion of the left temporal lobe. We tentatively diagnosed it as a right frontal brain tumor and attempted the total removal of the right frontal mass. Unexpectedly, pathological dia-gnosis was intracerebral granulation tissue associated with accumulation of hemosiderin-laden macrophages and capillary wall thickening. In addition, there was no reactive gliosis.

We speculated on the pathogenesis of intracerebral granulation tissue as follows. Since the patient was a heavy drinker and often fell down when he was drunk, it is likely that he might be suffering from intracerebral hematomas due to traumatic contusions. This assump-tion may be supported by the fact that an old subdural hematoma was observed during the operation and the radiological examination revealed multiple lesions. The gathering and proliferation of mesenchymal cells pos-sibly derived from blood circulation probably began at the site of the damaged brain tissue, thus forming in-tracerebral granulation tissue.

To avoid an unnecessary operation, it is important to watch the development of an intracerebral mass lesion when we suspect it may be of traumatic origin.