短期間に頻回の出血をくり返したChoriocarcinomaの1手術例

A Successfully Operated Case of Choriocarcinoma with Recurrent Intratumoral Hemorrhage

I．はじめに

　脳原発choriocarcinomaは易出血性であり，その出血により時に腫瘍出血死を来たすことは良く知られている．しかし，その発生頻度は極めて低いため，病態に関する理解は今もって不十分である．今回われわれは経過中数回の出血を繰り返しながらも，良好な経過を呈しているchoriocarci-nomaの1手術例を経験したので，本腫瘍の手術タイミングを中心に文献的考察を加えて報告する．

A 12-year-old boy with primary intracranial choriocarcinoma of the pineal region suffered from repeatedintratumoral hemorrhage over a short period. Neuroradiological images demonstrated a pineal-regiontumor with intratumoral hemorrhage and obstructive hydrocephalus. HCG-β subunit concentration of hisserum and cerebrospinal fluid was abnormally high. After the 24.2Gy irradiation, the tumor was removedalmost totally. After the operation, we treated him with additional radiation and chemotherapy using ifos-famide, cisplatin, and etoposide (namely ICE therapy).

No recurrence or metastasis has been noted, and be was in good condition during the 22 months sincethe operation. At present he receives maintenance ICE therapy every 3 months. Choriocarcinoma involvesa high possibility of intratumoral fatal hemorrhage, so a radical operation is recommended as soon aspossible.