蝶形骨に発生した巨細胞腫の1例

Giant Cell Tumor Originating in the Sphenoid Bone : a case report

I．はじめに

　巨細胞腫は全骨腫瘍の3-7％の頻度であり，好発部位は大腿骨遠位，脛骨近位，橈骨遠位などの長管骨骨端部で90％を占める．頭蓋骨に原発する頻度は1-3％で^3,5），その過半数は蝶形骨に発生し，次いで側頭骨，前頭骨，後頭骨，円蓋部などに生じる^{2,3,5-9,12,16,17,19-21,25,27）}．発症年齢は20-40歳台が多く女性にやや多い傾向がある^3,5,26）．蝶形骨を主座とする巨細胞腫はこれまでに70数例の報告があるものの，その治療法の詳細は確立されていない．頭蓋骨に原発した場合全摘出は困難で，放射線療法や化学療法の追加が必要である^{1-9,12,16,17,19-21,25-27）}．われわれは蝶形骨原発巨細胞腫例で摘出術と放射線治療にもかかわらず急速に増大し初期治療に難渋したものの，その後良好な経過が得られた1例を経験した．その画像所見と治療経過について若干の考察を加え報告する．

The authors report a case of giant cell tumor originating in the sphenoid bone. A 29-year-old womanpresented with headache and diplopia. Bilateral ophthalmoplegia developed and MRI showed rapid growthof the tumor in spite of transnasal removal and conventional radiation therapy. The second transnasalsurgery was performed 3 weeks after completion of radiotherapy. The symptoms were relieved except forright abducens palsy. Chemotherapy with cisplatin and etoposide was started after the second operation.The patient regained full ocular movement several months after the operation. Clinical remission has con-tinued for four years. We conclude that the combination of repeated operations in the initial phase of rapidtumor growth, irradiation and chemotherapy is important to achieve tumor control.