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Neurological Surgery No Shinkei Geka Volume 27, Issue 6 （June 1999）

Neurological Surgery 脳神経外科 27巻6号（1999年6月発行）

Japanese English

症例

特異な画像を示した微小嚢胞性髄膜腫の1例 Atypical Neuroradiological Features of Microcystic Meningioma : case report 塩屋斉 ¹ , 菊地顕次 ¹ , 須田良孝 ¹ , 進藤健次郎 ¹ , 南條博 ² Hitoshi SHIOYA ¹ , Kenji KIKUCHI ¹ , Yoshitaka SUDA ¹ , Kenjiro SHINDO ¹ , Hiroshi NANJYO ² ¹由利組合総合病院脳神経外科 ²由利組合総合病院病理 ¹Departments of Neurosurgery Yuri Kumiai General Hospital ²Departments of Pathology Yuri Kumiai General Hospital キーワード： microcystic meningioma , vacuolated meningioma , CT , MRI , angiography Keyword: microcystic meningioma , vacuolated meningioma , CT , MRI , angiography pp.569-575

発行日 1999年6月10日 Published Date 1999/6/10

DOI https://doi.org/10.11477/mf.1436901740

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Abstract 文献概要
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I．はじめに

　髄膜腫の多くはCTで診断されるが低吸収域を示すことは少ない．また組織学的に微小嚢胞変性を示した報告は非常に稀で，WHO脳腫瘍組織分類第2版（1993）^5）では亜型の1つとして微小嚢胞性髄膜腫と定義している．今回，特異な画像を示し術前診断が困難であった微小嚢胞性髄膜腫の1例を経験したので文献的考察を加えて報告する．

We report a rare case of microcystic meningioma presenting with atypical neuroradiological features.

A 76-year-old woman was admitted to our hospital in October, 1996 because of head heaviness withoutobvious neurological deficits.

Previous CT scan in 1989 revealed no abnormality, but a subsequent scan in 1992 showed a low-densityarea in the right frontal region. Since then the patient has been followed up as a case of cerebral infarction.At the time of the current admission, CT scan disclosed the low-density area as having grown to the sizeof 4cm and heterogeneously enhanced after injection of contrast medium. On MRI the mass lesion was de-picted as low-intensity on TI-weighted image and high-intensity on T2-weighted image. The mass washeterogeneously enhanced after administration of Gd-DTPA. Right internal and external carotid angio-grams revealed neither tumor feeder nor tumor stain. Craniogram showed neither hyperostosis nor boneerosion, and yet bone scintigram demonstrated markedly increased uptake involving the right frontal bonenear the tumor.

At surgery the tumor was found to have originated from the dura in the right frontal convexity, whichwas well demarcated and separated from the surrounding brain tissue. Total removal designated as Simp-son grade I procedure was accomplished. Light microscopy revealed abundant microcysts of varied sizethroughout the tumor tissue with the presence of whorl formation and psammoma body, but no malig-nancy was indicated. Electron microscopy further demonstrated interdigitation of the neighboring cellmembranes, desmosomes, and intracytoplasmic filaments, which are pathognomonic findings of menin-giomas. The microcysts were seen to reside in the extracellular spaces rather than in the cytoplasm. With these pathological findings, the tumor was finally diagnosed as microcystic meningioma.