Neurological Surgery 脳神経外科39巻10号

2011年10月発行

症例

胆管細胞癌よりの脈絡叢転移性腫瘍の1例

著者： 栗栖宏多¹ 鴨嶋雄大¹ 寺坂俊介¹ 小林浩之¹ 久保田佳奈子² 寳金清博¹

所属機関： ¹北海道大学病院脳神経外科 ²北海道大学病院病理部

ページ範囲：P.991 - P.997

Ⅰ．はじめに

　脈絡叢乳頭腫や脈絡叢乳頭癌は比較的稀な脳腫瘍である．その発生頻度は人口10万人当たり0.3人に発生するといわれ^9,10)，全脳腫瘍のうち0.4～0.8％³⁰⁾を占めるに過ぎない．一方で，頭蓋外原発の悪性腫瘍の脈絡叢転移も極めて稀である．われわれが渉猟し得た限りでは，過去に35例の報告^{3,7,13,20,23-26,28,29)}しかない．この35例のうち，原発巣としては腎癌の報告^23-26)が最も多く，次いで肺・大腸^7,24)と続いている．しかし，胆管細胞癌からの転移は過去に報告例はない．両者の鑑別はその稀少性ゆえに時として臨床所見（画像所見），病理所見において困難を伴う．

　今回，われわれは成人担癌患者（胆管細胞癌）に側脳室内脈絡叢部に腫瘍が認められた症例を経験した．画像所見，病理所見を含め原発性腫瘍，転移性腫瘍の鑑別が問題となったが，病理組織診断を用いて最終診断として転移性腫瘍との診断に至った．この非常に稀であり，診断に難渋した症例をその診断過程も含めて若干の文献的考察を加えて報告する．

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