軟部好酸球肉芽腫とアレルギー

ALLERGIC REACTIONS IN EOSINOPHILIC GRANULOMA OF THE SOFT TISSUE

　軟部好酸球肉芽腫は耳下腺部にもつとも多く，頬部，顎下部，涙腺などの顔面頸部に発生するものが過半数を占めている。この症例の報告はわが国でもつとも多く，東洋のみの疾患とされ，欧米でこれと同一の疾患として報告されたものはない。病理組織学的には皮下にリンパ瀘胞様構造をもち，リンパ結節の強い新生と高度の好酸球浸潤を示す疾患である。

　1948年木村^1）はこの病理組織学的特徴を報告した。1959年飯塚^2）はこれが他の骨や皮膚などの組織に発生する好酸球肉芽腫と異なり，世界の文献にも未だ明確な記載のない病変であることから，他の疾病との混乱を避け，一つの疾患単位として取扱うため木村氏病と呼ぶことを提唱した。そして木村の報告以前Mikulicz氏病などの名で報告されたものの中に，この疾患の混在していることが明らかになつてきた。

　Eosinophilic granuloma of the soft tissue is mostly found in the parotid region and in the face and neck including the cheek, submandibular and lacrimal region. This disease is solitary or multiple benign tumor. Histologically the eosinophilic granuloma of the soft tissue has lymphoid follicle, outstanding development of lymphoid node with migration of eosinophiles. The cases with this disease have been reported in Japan and other countries in the orient, but notin Europe and other Western countries. The causes have not been known yet.

　Allergic reactions of a case with eosinophilic granuloma of the soft tissue which involved the parotid gland were studied. The patient, eighte-en-year-old female, had a swelling of the size of a hen's egg in the left parotid region and did not get better by the administration of enzyme (antiinflammatory drug), antibiotics and salivary gland hormon, etc. The blood examination showed slight increase of neutrophiles and remarkable increase of eosinophiles (37%). ASLO titer was 333 units of Todd, but in urin, feces, and other blood examination nothing in particular was found. The histopathological findings were characterized by the increase of lymph follicles with the germinal center infiltrated by eosinophiles.

　The steroid treatment effectively reduced the tumorous swelling of the parotid region and the count of eosinophiles in the blood. But after the cessation of steroid therapy the swelling and eosinophiles recurred. The allergic intracutaneous test was found positive to candida and candida injection provoked edema and erythema at the site of the swelling in the parotid region. The desensitization by the intracutaneous injection and the injection of candida solution into the granuloma reduced the swelling and the count of eosinophiles.