胸壁に発生した悪性顆粒細胞腫の1例 [in Japanese] A CASE OF MALIGNANT GRANULAR CELL TUMOR ARISEN IN THE CHEST WALL [in Japanese]
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症例は68歳,女性で増大する左前胸部のしこりを主訴に来院. CT検査, MRI検査などでは第1肋間から胸腔内へ進展する大胸筋下の腫瘍で,針生検にて悪性顆粒細胞腫が疑われ切除手術を行った.免疫染色,電子顕微鏡検査を含む病理組織検査で悪性顆粒細胞腫と診断した.術後8カ月後の再診時にはすでに局所,左胸腔内に再発を認め,術後12カ月で死亡した.悪性例の予後は不良で,その原因は局所再発が多いことに加えリンパ節転移や肺転移もみられるためである.本症例では局所再発と胸膜転移,肺転移が認められた.稀な腫瘍であり化学療法や放射線療法は効果がないといわれ,治療の難しい疾患である.
A 68-year-old woman was seen at the hospital because of an enlarging lump in the left anterior thoracic region. Chest CT and magnetic resonance imaging scans showed that the lump was a tumor under the pectoralis major muscle extending from the first intercostal space to the thoracic cavity. Malignant granular cell tumor was suspected by a needle biopsy, and surgical resection was performed. Following histopathological studies including immunological staining and electron microscopy, malignant granular cell tumor was diagnosed. The patient already had local recurrence as well as recurrence in the left thoracic cavity when she was seen in the clinic 8 months after the operation, and died 12 months after the operation.<br> Malignant granular cell tumors have a poor prognosis resulting from not only frequent local recurrences but also lymph node and/or pulmonary metastases. In this case pleural and pulmonary metastases in addition to local recurrence were identified. This is a rare tumor and resists chemotherapy and radiotherapy so that we have great difficulties in the treatment.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 66(10), 2403-2406, 2005-10-25
Japan Surgical Association