Neurological Surgery 脳神経外科48巻10号

2020年10月発行

症例

テモゾロミド単独療法後，長期経過で悪性転化したびまん性星細胞腫の1例

著者： 矢花信亜¹ 小野隆裕¹ 高橋和孝¹ 清水宏明¹

所属機関： ¹秋田大学大学院脳神経外科

ページ範囲：P.941 - P.947

Ⅰ．はじめに
　びまん性星細胞腫（diffuse astrocytoma：DA）は成人の大脳半球に好発する髄内腫瘍で，World Health Organization（WHO）脳腫瘍病理分類ではgrade Ⅱに分類される．近年の分子生物学的研究により，DAを含む星細胞腫系腫瘍（astrocytic tumors：AT）は，「IDH（isocitrate dehydrogenase）1/2変異あり」かつ「1p/19q共欠失なし」という2つの遺伝子的特徴を有することが明らかとなり，2016年に改訂されたWHO脳腫瘍病理分類（WHO 2016）⁷⁾では，本特徴が診断基準として明記された．一方，WHO 2016以前では顕微鏡検査に基づいて病理診断が行われていたことから，過去にDAと診断された症例群の中には組織所見が類似するIDH野生型神経膠腫あるいは乏突起膠腫（oligodendroglioma：OD, IDH1/2変異および1p/19q共欠失あり）が含まれ，したがってDAに関する従来の臨床研究は，遺伝子診断に基づいた純粋なDAの治療成績を反映していないとされる^2,9,10,14)．WHO 2016以降，DAの長期的な転機に関する報告は未だ少なく，的確な治療を行うためには多くの症例の蓄積が望まれる．
　今回，初回摘出術後にテモゾロミド（temozolomide：TMZ）単独療法が行われ，11年の経過で再増大および悪性転化したDAの1例を経験したので，文献的考察を含めて報告する．

参考文献

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