鼻腔に発生したglomangiopericytomaの1症例

A case of glomangiopericytoma in the paranasal sinuses

はじめに

　Hemangiopericytomaは血管周囲細胞由来の腫瘍である。その約15〜30％が頭頸部領域に発生する^1）が，鼻腔にできることは稀である。一般に易出血であり，出血の制御にしばしば難渋する。鼻腔領域で発生したhemangiopericytomaはglomangiopericytoma（鼻腔型血管周囲細胞腫）と呼ばれ，症状として鼻閉，鼻出血が多くみられる。局所再発や転移もあることから臨床的に良・悪性中間型腫瘍とされる^2）。今回われわれは，手術を施行するにあたり多量の出血が予想されたため，血管塞栓術施行後に内視鏡下に腫瘍摘出を行ったglomangiopericytomaの1症例を経験したので報告する。

　Hemangiopericytoma is a rarely occurring soft-tissue tumor of perivascular cell origin that can arise in any part of body, and accounts for about 2〜5％ of all soft-tissue tumors. Approximately 15〜30％ of hemangiopericytomas occur in the head and neck area, and about 5％ of head and neck tumors manifest in the paranasal sinus area and are called glomangiopericytomas. Symptoms of nasal obstruction and bleeding are often seen. Due to their low potential for local recurrence and metastasis, glomangiopericytomas are clinically low malignant, well-differentiated tumors.

　A 63-year-old man with nasal bleeding, nasal obstruction and serous nasal discharge was referred to our university hospital about two years ago. A tumor was detected in the right nasal cavity. Biopsy was accompanied by copious bleeding. There were no findings of malignancy, and a fibrous histocytoma was diagnosed initially. MRI showed that it developed in the epipharyngeal space of the right nasal cavity, and T1-weighted low-signal, T2-weighted high-signal and T1-weighted contrast-enhanced imaging showed dense staining. MRA showed that a blood vessel coursing from the dorsal side of the orbital cavity fed the tumor via the nasal septum. The tumor was totally removed by endoscopic surgery after embolizing the blood vessel to prevent extensive bleeding. Blood loss during the operation was 200 mL. Pathological examination resulted in the diagnosis of glomangiopericytoma. Based on the previous reports and this case, we concluded that blood vessel embolization should be performed before surgery for tumors that fill the nasal cavity or arise from behind the cavity.