鞍上部に発生した血管芽細胞腫と胸髄髄膜腫を合併した1例

A Case of Suprasellar Hemangioblastoma with Thoracic Meningioma

I．はじめに

　血管芽細胞腫は，一般に成人の小脳半球に好発する良性腫瘍であるが，天幕上の発生は稀である．Francoisらの報告では血管芽細胞腫の天幕上での発生は2.9％に過ぎないとしている^5）．Morel-loとBianchiらの1963年の報告では1,483例の天幕上腫瘍で血管芽細胞腫は2例のみと述べている^8）．

　今回われわれは，鞍上部に発生した血管芽細胞腫と胸髄髄膜腫を合併した1例を経験したので若干の考察を加えて報告する．

Supratentorial hemangioblastoma is encountered very rarely, with only about 110 cases reported. Thisreport concerns a case of a suprasellar hemangioblastoma associated with thoracic meningioma. A 62-year-old man was admitted with visual disturbance of the left eye. T2-weighted magnetic resonance imaging(MRI) showed a high signal intensity mass in the suprasellar region without perifocal edema. T1-weightedMRI with gadolinium showed a homogeneously enhanced mass. The angiogram revealed remarkabletumor staining originating from the right and left internal carotid arteries (ICA) and the left external caro-tid artery (ECA). On the basis of the pre-operative diagnosis of tuberculum sellae meningioma, total tumorremoval was performed. Photomicrographs of the specimen showed numerous capillaries divided by stro-ma cells, Positive immunostaining for factor VIII related antigen (F VIII RAg)was observed in endothe-lial cells, but immunostaining for epithelial membrane antigen (EMA) was not observed in any cells, A di-agnosis of suprasellar hemangioblastoma was made on the basis of these findings. The patient suffered pa-raparesis on the postoperative seventh day. Since MRI showed a thoracic tumor, a second total tumor re-moval was performed, The tumor was diagnosed as a meningothelial meningioma. The patient was dis-charged without evidence of new neurological deficits. Our experience shows that, when a mass is vascula-rized in the cerebral hemisphere, the possibility of hemangioblastoma needs to be taken into consideration.