血管塞栓術が鼻内視鏡下摘出に有用であった鼻副鼻腔血管外皮腫の1症例

Complete resection of paranasal hemangiopericytoma by endoscopic sinus surgery using preoperative superselective embolization

Ⅰ　はじめに

　易出血性鼻副鼻腔腫瘍では，生検時の鉗除操作で多量の出血が生じ，採取される検体量が不十分となり正確な病理診断が得られないことがある。腫瘍の摘出に際しては，腫瘍の進展範囲を十分に把握したうえで，出血への対応を治療戦略に組み込む必要がある。今回われわれは，易出血性腫瘍である血管周囲細胞腫（hemangiopericytoma）に対して，術前に血管塞栓術を行うことにより，比較的少量の出血で内視鏡下に腫瘍を一塊として摘出し得たので，本症例の治療経過と血管外皮腫の診断と治療上の問題点について文献的考察を加えて報告する。

　A 35-year-old woman complained of right nasal obstruction and occasional nasal bleeding. A whitish tumor was found in the right middle meatus. Massive hemorrhage from the tumor was seen when the biopsy was performed. A small amount of biopsy specimen indicated angiofibroma. Her pregnancy and child care compelled us to postpone the surgical treatment for more than three years. The tumor became as twice as large in its volume three years later. En bloc resection of the tumor was performed by endoscopic sinus surgery two days after embolization of its feeding vessels. The final pathological diagnosis was hemangiopericytoma both from the characteristic histology with the stag horn-like structure in HE stain and the histochemical examinations. She has had neither local recurrence nor metastases two years after the surgery.