松果体部奇形腫全剔，15年後に発症したtwo cell pattern pinealomaの1例

A CASE OF TWO CELL PATTERN PINEALOMA, DEVELOPED 15 YEARS AFTER TOTAL REMOVAL OF PINEAL TERATOMA

I．はじめに

　松果体腫瘍は，とくに我国において高頻度にみられ，今までにも数多くの報告がなされてきた。しかしながら，その中でも最も頻度の高いtwo cell pattern pinealomaの由来細胞，分類上の位置づけについては，未だgerm　cell origin, pineal parenchymal cell originの2説があり，意見の一致をみていない。我々はかって九州大学友田外科にて松果体部奇形腫の全剔出手術をうけ（本邦手術成功第3例^4,5））15年後に眼球運動障害，精神機能低下，Simmonds症候群を呈し，諸検査にて第3脳室底部に発育した異所性松果体腫と診断されたが，全身衰弱で死亡，剖検にて，two cell pattern pinealomaと判明した極めて稀れな症例を経験したので報告する。

A discrete pineal tumor (histologically : mature tridermoma without pinealoma component) was suc-cessfully removed from a boy, aged 7 yrs. Fifteen years after the operation, he became somnolent and was revealed to have anisocoria, disturbance of up-and downward gaze, combined with paresis and regidity of the left upper and lower limbs. In his admission to our clinic at the age of 22 yrs, a tumor mass was found on the third ventricle floor by pneumo-ventriculography (Fig. 1), and diagnosed as "Ectopic pinealoma". Endocrinological exami-nation revealed anterior pituitary hypofunction. After replacement therapy by hydrocortisone, his consciousness became gradually clear. While irra-diation therapy was postponed because of remarkable general prostration, he died of bronchopneumonia 7 months after hospitalization.

On postmortem examination, two cell patternpinealoma was found in and around the ventricle system (Fig. 2, 3, 4, 5). Among 97 cases of pineal neoplasms, we have so far experienced, 10 were histologically teratomas and adenocarcinomas com-bined with two cell pattern pinealomas. However, the presented case is the only one of two cell pattern pinealomas, clinically manifested a long time after the removal of pineal teratoma.

In view of "Germ cell theory" by Russel, we suppose that the germ cells transformed into two cell pattern pinealoma in the third ventricle, after removal of the pineal teratoma, performed 15 years ago.