皮膚軟部腫瘍の診療における病理組織学的セカンドオピニオンの重要性に関する2例

Two Case Studies of the Importance of Second Pathology Opinions in the Treatment of Skin and Soft Tissue Tumors

はじめに

　皮膚軟部腫瘍の診療において病変の良悪性に関する術前診断の正確性は，適切な治療の選択や優先順位に重大な影響を及ぼす。

　今回われわれは，他院で悪性病変と診断され当科に紹介された皮膚軟部腫瘍の患者に対して，病理組織学的セカンドオピニオンを行った結果，良性の診断に覆ったために不適切な手術を回避できた2症例を経験したので報告する。

　We describe the cases of two patients with cutaneous soft tissue tumors who had initially been diagnosed with malignant lesions at other hospitals; upon seeking a second pathology opinion from our department, their diagnoses were revised to benign, thus avoiding inappropriate surgeries. The first patient was a 37-year-old woman previously diagnosed with dermatofibrosarcoma protuberans for the right buccal. She was re-diagnosed with nodular fasciitis at our hospital. The other patient was a 32-year-old woman previously diagnosed with adenocarcinoma in the umbilical region. She was re-diagnosed with endometriosis at our hospital. In both cases, surgical procedures were cancelled and the patient underwent a follow-up examination. Diagnostic discrepancies among pathologists are reported to be higher in specific organ systems, including the female genital organs, gastrointestinal tract, and skin. The management of cutaneous soft tissue malignancies should thus be approached cautiously, considering the potential for diagnostic revisions as outlined above.