腫瘍内出血を伴った脊髄髄内転移性腫瘍の1例

Intramedullary Spinal Cord Metastasis Associated with Hemorrhage : a case report

I．はじめに

　悪性腫瘍の脊髄髄内転移は，比較的稀とされ，悪性腫瘍剖検例の2.1％を占めると言われている^2）．そのうち髄内出血を伴う症例は非常に稀であり，今まで数例しか報告されていない^{6,8,10,12，13）}．出血例ではその時点で症状が急激に悪化することがあるため，血管障害との鑑別も問題となる．

　今回われわれは，亜急性に対麻痺の進行を来たした脊髄円錐上部の髄内転移性腫瘍の腫瘍内出血例を経験したので，若干の論文的考察を加え，報告する．

A rare case of intramedullary spinal cord metastasis associated with hemorrhage was reported. A 74-year-old man had a subacute onset of paraparesis. He became almost paraplegic within a few days. MRI revealed an intramedullary spinal lesion in the epiconus at the Th 11 and Th 12 level, but spinal angiogra-phy did not show any abnormality. Since repeated MRI showed enlargement of the lesion, surgery was performed under the diagnosis of an intramedullary spinal cord tumor. Under general anesthesia, a midline myelotomy of about 3 cm was performed and a grayish, elastic and circumscribed tumor as well as a li-quefied hematoma in the caudal part was observed. Both the tumor and the hematoma were removed almost totally. The patient's paraparesis improved slightly after surgery. The histological diagnosis was adenocarcinoma. The primary source was unknown, but multiple small metastatic tumors were found in the lung, liver and brain, etc. Hemorrhage from intramedullary spinal cord metastasis is extremely rare with only 6 reported cases in the recent literature. Rapid deterioration of symptoms caused by the hemato-ma may make the diagnosis more difficult. Indication of surgical treatment should be carefully determined because prognosis of intramedullary spinal cord metastasis is generally very poor.