中年男性に発生した原発性松果体部胎児性癌の1例

Primary Pineal Embryonal Carcinoma Occurring in a Middle Aged Man

I．はじめに

　頭蓋内原発の胎児性癌はきわめて稀であり，中年以降にprimary intra-cranial germ cell tumor（以下GCT）が発生することもまた稀である．今回われわれは，42歳男性の松果体部に発生したpure embryonal carcinoma（以下EC）を経験したので文献的考察を加え報告する．

A case of a primary pineal embryonal carcinoma occurring in a middle aged man is reported. A 42-year-old man suffering from headache and nausea was referred to our department. A neurological examination revealed that he had Parinaud's sign. Head CT and MRI showed a tumor in the pineal region. He was operated on using the occipital trans-tentorial approach. The tumor was partially removed and an intra-op-erative specimen was used to diagnose a kind of germ cell line tumor.

However, the tumor was diagnosed afterwards as a pure embryonal carcinoma. Three courses of PE chemotherapy followed by 30Gy of whole craniospinal irradiation and 30Gy of extended local irradiation were completed. An MRI showed the tumor to be in complete remission. Despite careful follow-up with chemotherapy every three months, a re-operation and linac radio-surgery, the tumor recurred, and dissemi-nated. The patient died due to an intra-tumoral hemorrhage. A pure primary pineal embryonal carcinoma occurring in a middle-aged person has never been reported prevoiusly in detail.