抄録
症例は57歳, 男性.1995年に鼻咽頭癌にて腫瘍摘出術および放射線治療を施行後, 1997年より2004年までに左第7肋骨, 左壁側胸膜の転移に対して手術療法, 胸椎(Th7, 8), 左大腿骨骨幹部, 腹部傍大動脈部の転移に対して放射線療法を行い, 間歇的に化学療法を施行されてきた.2004年7月ごろより左胸側背部痛の出現を認めたため胸部CTを施行したところ, 左第7肋骨の前側方の切除断端部位と左第8肋骨背側部から第7肋間の傍脊柱領域にかけての壁側胸膜に不整な肥厚像を認めた.MRIとthin slice CTで傍脊柱領域の胸膜肥厚は左第7, 8胸椎椎間孔に伸展し脊柱管内で腫瘤を形成していた.後方からの左片側椎弓切除と側方開胸下に各腫瘍を切除し, いずれも鼻咽頭癌の転移の診断を得た.傍脊柱領域の胸壁腫瘍は, 神経原性腫瘍以外でも, MRIやthin slice CTにより椎間孔や脊柱管内の検索を行う必要があると考えられた.
A 57-year-old man had received the tumor resection and radiation therapy for naso-pharyngeal cancer in 1995. After the operation, several metastases were treated; the resection of left 7th rib and tumor in the left parietal pleura, and radiation therapy for thoracic vertebrae (Th7, 8), left femur and upper abodominal para-aortic area. He developed left lateral chest pain and chest CT revealed a mass shadow attached to the left 7th rib and irregular thickness of parietal pleura, which exists in the left 8th rib from left 7th intercostals space of the paravertebral sulcus. Chest MRI and thin slice CT showed the tumor extended into the thoracic spinal canal through the left intervertebral foramen of Th7-8. The operation for the dumbbell tumor was performed with left hemi-laminectomy of Th7-8 and thoracotomy. A histopathological examination revealed the tumors to be metastases of naso-pharyngeal cancer. Generally, most dumbbell tumors are neurogenic tumors. However, in the case of chest wall tumors beside vertebrae, examination for intervertebral foramen should be performed with MRI and thin sliced CT.
