側頭葉焦点切除標本にて海綿状血管腫と皮質形成異常の共存が認められた1例

A Case of Coexistence with Cavernous Angioma and Focal Cortical Dysplasia

症例は24歳男性。全身性痙攣発作にて発症し，脳MRIにて左側頭葉先端部にhemosiderin rim を有するmass lesion を認めた。脳波解析の結果，てんかん焦点は左側頭葉外側にあると判断し，前側頭葉切除後腫瘍を全摘した。病理所見にて腫瘍本体は海綿状血管腫と診断した。側頭葉外側の切除標本では，一部にdyslaminationを認め，皮質形成異常の合併と考えられた。われわれが調べ得た限り海綿状血管腫と皮質形成異常の共存例はこれまで報告がなく，貴重な1例であると考えられた。また，perineuronal glial satellitosisを伴ったwhite matter neuronをdyslaminationを認めた近傍の皮質下白質に認めたことから，これらは神経細胞の遊走障害に密接に関連した奇形的変化である可能性が示唆された。

There have recently been a number of new pathological findings of specimens from epileptic foci that have become widespread of surgical treatment. We reported a case with seizures resulting from brain lesions which pathologically demonstrated a coexistence with a cavernous angioma and a focal cortical dysplasia.

　A 24-year-old man was admitted to our hospital because of generalized convulsion from 1 year ago. Brain MRI revealed an enhanced mass lesion, in diameter 1.5 cm, with hemosiderin rim in the left temporal tip. Ictal EEG showed the initiation of the spike from the lateral side of the left temporal lobe. Because the epileptogenic focus was thought to be the lateral side in the left temporal lobe, anterolateral temporal resection was performed and subsequently total removal of the tumor was performed. He had no seizure after surgery. A light microscopic examination was performed on specimens stained with hematoxilin and eosin. We verified to be pathologically coexistent with a cavernous angioma and a focal cortical dysplasia. We also found unusual neurons that were accompanied by perineuronal glial satellitosis in the subcortical white matter, those were occasionally observed in epileptic foci and were thought to be a form of neuronal migration disorders.