腫瘍内出血を伴った頭蓋咽頭腫の1例

A Case of Craniopharyngioma with Intratumoral Hemorrhage

I．はじめに

　頭蓋咽頭腫からの出血の頻度は非常に稀であるが，今回われわれは，腫瘍内出血により下垂体卒中様症状で発症した頭蓋咽頭腫の1例を経験した，本例の臨床経過，画像所見は興味深く，文献的考察を加えて報告する．

A patient of craniopharyngioma associated with intratumoral bleeding was reported. A 44-year-oldfemale was admitted to our department with sudden onset of headache suggesting pituitary apoplexy. Onadmission, she complained of mild bifrontalgia and neurological examination revealed no abnormality ex-cept bitemporal hemianopsia. Hormonal examination indicated hypopituitarism with masked diabetes in-sipidus and chronic thyroiditis. MRI showed a cystic 12×10×10mm tumor with an enhanced rim at theintra- and suprasellar region. The MRI findings of the cyst suggested intratumoral bleeding with variousstages. CT and plain tomography revealed plane calcification adjusting or aligning itself to the floor of thesellar. This calcification was difficult to distinguish from the sellar floor on MRI. Under the diagnosis ofcraniopharyngioma, almost all of the tumor was removed, using the transsphenoidal approach. The cystconsisted of old hematoma and cholesterin. The histological examination revealed a stratified squamousepithelia with numerous immature blood vessels. Such findings are unusual in cases of craniopharyngioma.Craniopharyngioma is rarely associated with intratumoral hemorrhage. The mechanism of this hemorrhagewas discussed with reference to the literature on this subject.