上顎脂肪肉腫—症例報告と文献的考察

Liposarcoma of the Maxilla: Report of a Case

　I．緒言

　軟部組織悪性腫瘍のうち，脂肪肉腫は頻度の高いものである。しかし，頭頸部においては極めてまれであり，英語文献を中心として筆者らの渉猟しえた範囲では，本例を含めて64例にすぎない。本邦では，上顎より発生した脂肪肉腫の報告は，尾崎ら^1）の3例，佐藤^2）の1例のみである。

　今回，筆者らは，上顎悪性腫瘍を疑い，術前照射，手術を行った結果，線維腫とされたが，約3年後に再発し，脂肪肉腫と確定診断された1剖検例を経験したので，若干の文献的考察を加えて報告する。

　Liposarcoma is one of the most common malignant tumors in the soft tissue. In the head and neck, however, liposarcoma is rarely encountered. A 33-year-old male presented a mass of 3 month's duration with rapid increase in size in the gingiva of the left upper molar teeth region. After linac teleradiotherapy of 3000 rad, partial maxillectomy was performed. Histopathological study revealed a fibroma with fibromyxomatous change. Three years after the surgery, the patient complained of swelling of the left cheek, right temporal scalp and right abdominal wall. Biopsy specimens showed liposarcoma. Although electron radiotherapy of 5000 rad and combined chemotherapy with actinomycin-D, vincristine and cyclophosphamide were given, the response was unsatisfactory and the metastases to the lungs, and left facial paralysis were appeared. The patient died about 4 years after onset of symptoms. At autopsy, tumor metastases were found in the lungs, heart, kidney, spleen, liver, small intestine and subcutaneous tissues.

　Sixty-four cases of liposarcoma, arising in the head and neck, collected from the literature were reviewed, and of histopathological differential diagnosis and methods of treatment were discussed.