脊髄圧迫症状で発症した硬膜外脊髄顆粒球肉腫  [in Japanese] Granulocytic sarcoma presenting as an epidural mass with spinal cord compression  [in Japanese]

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Abstract

症例は73歳,男性。急激に発症した背部痛と下肢の麻痺で入院した。胸椎のガドリニウム造影MRIで第4∼6胸椎レベルで右後方から脊髄を圧排する硬膜外脊髄腫瘤と第5∼6胸椎体の増強像を認めた。速やかに椎弓切除術が施行されたが,麻痺は改善しなかった。生検像では,細胞質のわずかな未分化な非特異的円形細胞の集塊がみられ,抗ミエロペルオキシダーゼ抗体に陽性反応を示し,顆粒球肉腫と診断した。2カ月後,前胸壁に転移と思われる顆粒球肉腫が出現した。両腫瘤に対し放射線療法を施行したところ腫瘍は縮小した。しかし,経過中に敗血性ショックで死亡した。顆粒球肉腫の多くは骨髄性白血病や骨髄増殖性疾患の経過中にみられ,本例のような骨髄病変を認めない「非白血病性」の顆粒球肉腫(“nonleukemic” granulocytic sarcoma)は稀で,これまでに8例の症例報告がみられるにすぎない。

A 73-year-old man was admitted because of back pain and paralysis of the lower extremities. Magnetic resonance imaging of the spine at the Th4∼6 level, obtained after gadolinium injection, demonstrated abnormal signal intensity within the Th5∼6 vertebral bodies and an extradural soft-tissue mass on the right posterior side of the spinal canal, compressing the thecal sac. The patient underwent prompt decompression with laminectomy, but this was unsuccessful. A biopsy sample of the mass revealed the histological features of granulocytic sarcoma, including diffuse infiltration of numerous cells containing cytoplasmic granules and immunohistochemical positivity for myeloperoxidase. Two months later, a subcutaneous soft-tissue mass appeared at the anterior chest wall, and this was confirmed to be granulocytic sarcoma by microscopic examination. Both of these tumors were radiosensitive, but the patient died of septic shock. Granulocytic sarcoma usually occurs in association with leukemia or other myeloproliferative disorders. However, it is rarely found before leukemia becomes evident in the peripheral blood or bone marrow; only eight such instances have been reported previously.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 41(8), 653-657, 2000-08-30

    The Japanese Society of Hematology

References:  9

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008038080
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    04851439
  • NDL Article ID
    6295735
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-295
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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