多発性骨髄腫治療中に急激な増大を呈した神経膠芽腫の1例

Rapid Growth of Glioblastoma during Therapy for Multiple Myeloma : case report

I．はじめに

　多発性骨髄腫は他の悪性腫瘍を合併しやすいことが知られているが^7），神経膠腫と多発性骨髄腫の重複腫瘍は非常に報告が少ない．今回われわれは多発性骨髄腫の治療中に，急速な増大を呈した神経膠芽腫の1例を経験したので，若干の文献的考察を加え報告する．

Rapid growth of a glioblastoma during therapy for multiple myeloma is reported.

A 53-year-old man was admitted to our hospital with a right costal tumor, which was resected. The di-agnosis was plasmocytoma. Urine protein electrophoresis showed a monoclonal peak in the region ofγ-globulin, and examination of the bone marrow revealed 17.8% of atypical plasma cells. Brain magneticresonance (MR) imaging detected two small lesions, but these could not be identified as brain tumor. Hereceived chemotherapy (melphalan 10mg/day and predonin 30mg/day for 4 days) and was discharged.

Two weeks after discharge, he was readmitted because of left hemiparesis. T1-weighted MR imagingshowed two large hypointense lesions in the right frontal lobe, with ring-like enhancement following Gd-DTPA infusion. ¹H-MR spectroscopy showed typical findings of tumor with increased choline and lacticacid peaks. ²⁰¹T1 SPECT revealed high accumulation in both early and delayed images. Right carotidangiography showed a hypervascular tumor with venous filling and mass effect. The lesions were resectedvia right frontal craniotomy, followed by intraoperative radiation and placement of an Ommaya reservoir.Histological examination showed the tumors were glioblastoma. The brain between the tumors alsoshowed the typical appearance of glioblastoma, suggesting that the lesions were continuous. Postoperative-ly, the patient's left hemiparesis disappeared. He received local irradiation and chemotherapy and was thendischarged.

Coexistence of glioblastoma and multiple myeloma is rare. The cause may be genetic abnormality, butimmunodeficiency due to multiple myeloma, surgical damage, or chemotherapy may have contributed tothe rapid growth of the glioblastoma.