Neurological Surgery 脳神経外科37巻6号

2009年06月発行

症例

小脳に発生したpleomorphic xanthoastrocytomaの1例

著者： 眞野唯¹ 金森政之¹ 園田順彦¹ 隈部俊宏¹ 渡辺みか² 冨永悌二¹

所属機関： ¹東北大学大学院神経外科学分野 ²東北大学病院病理部

ページ範囲：P.586 - P.590

Ⅰ．はじめに

　Pleomorphic xanthoastrocytoma（PXA）は1979年に報告された，若年に発症する星細胞腫の一亜型でWHO gradeⅡに分類される腫瘍である．好発部位はテント上，特に側頭葉であり，その好発部位より痙攣発作やてんかんの長期経過のうちに発見されることが多い^3,7,12)．一方で小脳の発生例は現在までに16例の報告があるのみである^{1,2,4-6,8-11,14-19)}．一般に予後良好であるが，10～20％に再発あるいは悪性転化がみられるとの報告もある¹³⁾．

　今回われわれは，成人の小脳虫部に発生したPXAの1症例を経験したので，画像所見，病理所見について文献的考察を加え報告する．

参考文献

1）Chang HT, Latorre JGS, Hahn S, Dubowy R, Schelper RL：Pediatric cerebellar pleomorphic xanthoastrocytoma with anaplastic features：a case of long-term survival after multimodality therapy. Childs Nerv Syst 22：609-613, 2006

2）Evans AJ, Fayaz I, Cusimano MD, Laperriere N, Bilbao JM：Combined pleomorphic xanthoastrocytoma-ganglioglioma of the cerebellum. Arch Pathol Lab Med 124：1707-1709, 2000

3）Giannini C, Scheithauer BW, Burger PC, Brat DJ, Wollen PC, Lach B, O’Neill BP：Pleomorphic xanthoastrocytoma：what do we really know about it? Cancer 85：2033-2045, 1999

4）Gil-Gouveia R, Cristino N, Farias JP, Trindade A, Ruivo NS, Pimentel J：Pleomorphic xanthoastrocytoma of the cerebellum：illustrated review. Acta Neurochir (Wien) 146：1241-1244, 2004

5）Glasser RS, Rojiani AM, Mickle JP, Eskin TA：Delayed occurrence of cerebellar pleomorphic xanthoastrocytoma after supratentorial pleomorphic xanthoastrocytoma removal. Case report. J Neurosurg 82：116-118, 1995

6）Hamlat A, Strat AL, Guegan Y, Ben-Hassel M, Saikali S：Cerebellar pleomorphic xanthoastrocytoma：case report and literature review. Surg Neurol 68：89-95, 2007

7）Kepes JJ, Rubinstein LJ, Eng LF：Pleomorphic xanthoastrocytoma：a distinctive meningocerebral glioma of young subjects with relatively favorable prognosis. A study of 12 cases. Cancer 44：1839-1852, 1979

8）Kumar S, Retnam TM, Menon G, Nair S, Bhattacharya RN, Radhakrishnan VV：Cerebellar hemisphere, an uncommon location for pleomorphic xanthoastrocytoma and lipidized glioblastoma multiformis. Neurol India 51：246-247, 2003

9）Kurschel S, Lellouch-Tubiana A, Kulkarni AV, Sainte-Rose C：Pleomorphic xanthoastrocytoma of the cerebellopontine angle in child. Childs Nerv Syst 22：1479-1482, 2006

10）Lim SC, Jang SJ, Kim YS：Cerebellar pleomorphic xanthoastrocytoma in an infant. Pathol Int 49：811-815, 1999

11）Lindboe CF, Cappelen J, Kepes JJ：Pleomorphic xanthoastrocytoma as a component of a cerebellar ganglioglioma：case report. Neurosurgery 31：353-355, 1992

12）Louis DN, Ohgaki H, Wiestler OD, Cavenee WK：WHO Classification of Tumours of the Central Nervous System, 4th edition. IARC, Lyon, 2007, pp22-24

13）Marton E, Feletti A, Orvieto E, Longatti P：Malignant progression in pleomorphic xanthoastrocytoma：Personal experience and review of the literature. J Neurol Sci 252：144-153, 2007

14）Naidich MJ, Walker MT, Gottardi-Littell NR, Han G, Chandler JP：Cerebellar pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Neuroradiology 46：825-829, 2004

15）Perry A, Giannini C, Scheithauer BW, Rojiani AM, Yachnis AT, Seo IS, Johnson PC, Kho J, Shapiro S：Composite pleomorphic xanthoastrocytoma and ganglioglioma：Report of four cases and review of the literature. Am J Surg Pathol 21：763-771, 1997

16）Powell SZ, Yachnis AT, Rorke LB, Rojiani AM, Eskin TA：Divergent differentiation in pleomorphic xanthoastrocytoma. Evidence for a neuronal element and possible relationship to ganglion cell tumors. Am J Surg Pathol 20：80-85, 1996

17）Rosemberg S, Rotta JM, Yassuda A, Velasco O, Leite CC：Pleomorphic xanthoastrocytoma of the cerebellum. Clin Neuropathol 19：238-242, 2000

18）Saikali S, Le Strat A, Heckly A, Stock N, Scarabin JM, Hamlat A：Multicentric pleomorphic xanthoastrocytoma in a patient with neurofibromatosis type 1. Case report and review of the literature. J Neurosurg 102：376-381, 2005

19）Wasdahl DA, Scheithauer BW, Andrews BT, Jeffrey RA Jr：Cerebellar pleomorphic xanthoastrocytoma：case report. Neurosurgery 35：947-951, 1994