腹腔鏡下に切除した腰仙骨神経叢由来後腹膜神経鞘腫の1例

Laparoscopic tumor resection for schwannoma originating from the lumbosacral plexus

◆要旨：症例は38歳の女性．子宮癌検診時に骨盤内に腫瘤を指摘され当院紹介となった．腹部CTで左内腸骨動脈の後方で左梨状筋に接し不均一な造影効果を伴う55mm大の境界明瞭な腫瘤を認めた．骨盤MRIではT1等信号，T2高信号のいわゆるtarget signを呈していた．神経鞘腫を疑い，腹腔鏡による経腹膜アプローチで腫瘍摘出術を行った．腫瘍は腰仙骨神経叢の背側から神経を押し上げるように存在しており，損傷しないよう慎重に剝離し摘出した．病理組織上，Antoni A型とB型の混在を呈し，また免疫染色でS100蛋白が陽性であり，神経鞘腫と診断した．術後一時的に下肢のしびれを認めたがすみやかに改善し，現在再発なく経過している．

　A 38-year-old woman was admitted to our hospital with a pelvic tumor. CT and MRI showed a tumor measured 55mm in diameter in the left pelvic cavity. After the tumor was diagnosed as schwannoma based on the imaging findings, laparoscopic resection was conducted. Since the tumor was located under the lumbosacral plexus, we paid attention to prevent nerve injury. The final pathological diagnosis was determined to be a schwannoma, and the postoperative course has been uneventful so far.