上位頸椎硬膜内に発生したxanthogranulomaの1例

A case of intradural xanthogranuloma in the upper cervical spine

I．はじめに

　Xanthogranulomaはその大半が皮膚にできるとされ，残り数％が眼，中枢神経系等，その他の部位に発生するといわれている^{2,3,5,6,12,16,22）}．中枢神経系の中でもその大半は，脈絡叢や小脳テントなど頭蓋内に生じ，脊椎にできる例は極めて稀である^{5,6,16,19,23）}．われわれは頸椎硬膜内に発生したxanthogranulomaの稀な1例を経験したので考察と共に報告する．

An 18-year-old female patient suffered from posterior neck pain and gait disturbance. The neurological ex-amination revealed left hemiparesis, general hyperreflex-ia and hypoalgesia on the right neck and upper limb, and left trunk and lower limb. MRI showed a large mass lesion in the right side of the spinal canal at the level of the C1 cervical spine, which was obviously compressing the spinal cord. An operation was per-formed through a right suboccipital craniectomy and right hemilaminectomy of the first vertebra. Though the mass lesion in the subarachnoid space compressed the spinal cord, it adhered neither to the spinal cord nor to the nerve roots. However, as it clearly adhered to the dura mater, the attachment site was also completely removed. In the pathological examination, lymphocyte, foamed macrophage and the giant cell of Touton type were shown. The immunohistochemical study with CD68 (Kp1) was positive, but it was negative for the lysozyme, neuron specific enolase and S-100 protein. The diagnosis was xanthogranuloma. The patient reco-vered completely after the operation. This is a rare case of juvenile type xanthogranuloma. This lesion in the spinal canal has usually its onset in the adult age.