Neurological Surgery 脳神経外科48巻9号

2020年09月発行

症例

くも膜下出血を呈したdiffuse leptomeningeal glioneuronal tumorの1例

著者： 五十嵐晃平¹ 川並香菜子¹ 山木哲¹ 松田憲一朗¹ 小森隆司² 園田順彦¹

所属機関： ¹山形大学医学部脳神経外科学講座 ²東京都立神経病院検査科

ページ範囲：P.801 - P.808

Ⅰ．はじめに
　Diffuse leptomeningeal glioneuronal tumor（DLGNT）は脳実質内への浸潤や腫瘍塊形成を認めずに，脳表の軟膜を中心にびまん性に分布することが特徴的な腫瘍である．過去の報告では，disseminated oligodendroglioma-like leptomeningeal neoplasmやprimary leptomeningeal oligodendro-gliomatosisなどの名称で呼ばれていたが，特徴的な病理組織学的・分子遺伝子学的性質を有することがわかり，World Health Organization（WHO）分類改訂第4版（2016年版）⁷⁾より独立した存在として記載された．小児から若年成人に多くみられ，やや男性に多い^5,10,11,14)．多くは緩徐な経過を呈するが，急性の経過を呈する例が一定数報告されている^{2,4,5,9-11,16)}．
　今回われわれは，経過中にくも膜下出血を合併したDLGNTの1例を経験した．文献的考察を加えて報告する．

参考文献

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2) Cho HJ, Myung JK, Kim H, Park CK, Kim SK, Chung CK, Choi SH, Park SH：Primary diffuse leptomeningeal glioneural tumors. Brain tumor Pathol 32：49-55, 2015

3) Deng MY, Sill M, Chiang J, Schittenhelm J, Ebinger M, Schuhmann MU, Monoranu CM, Milde T, Wittmann A, Hartmann C, Sommer C, Paulus W, Gärtner J, Brück W, Rüdiger T, Leipold A, Jaunmuktane Z, Brandner S, Giangaspero F, Nozza P, Mora J, Morales la Madrid A, Cruz Martinez O, Hansford JR, Pietsch T, Tietze A, Hernáiz-Driever P, Stoler I, Capper D, Korshunov A, Ellison DW, von Deimling A, Pfister SM, Sahm F, Jones DTW：Molecularly defined diffuse leptomeningeal glioneuronal tumor（DLGNT）comprises two subgroups with distinct clinical and genetic features. Acta Neuropathol 136：239-253, 2018

4) Fiaschi P, Badaloni F, Cagetti B, Bruzzone L, Marucci G, Dellacha A, Pavanello M, Ganci G, Padolecchia R, Valsania V：Disseminated oligodendroglial-like leptomeningeal tumor in the adult：case report and review of the literature. World Neurosurg 114：53-57, 2018

5) Gardiman MP, Fassan M, Orvieto E, D'Avella D, Denaro L, Calderone M, Severino M, Scarsello G, Viscardi E, Perilongo G：Diffuse leptomeningeal glioneuronal tumors：a new entity? Brain Pathol 20：361-366, 2010

6) Ko MW, Turkeltaub PE, Lee EB, Gonatas NK, Volpe NJ, Moster ML, Galetta SL：Primary diffuse leptomeningeal gliomatosis mimicking a chronic inflammatory meningitis. J Neuro Sci 278：127-131

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10) Preuss M, Christiansen H, Merkenschlager A, Hirsch FW, Kiess W, Müller W, Kästner F, Henssler A, Pekrun A, Hauch H, Nathrath M, Meixensberger J, Pietsch T, Kuchelmeister K：Disseminated oligodendroglial cell-like leptomeningeal tumors：preliminary diagnostic and therapeutic results for a novel tumor entity. J Neurooncol 124：65-74, 2015

11) Rodriguez FJ, Perry A, Rosenblum MK, Krawitz A, Cohen KJ, Lin D, Mosier S, Lin MT, Eberhart CG, Burger PC：Disseminated oligodendroglial-like leptomeningeal tumor of childhood：a distinctive clinicopathologic entity. Acta Neuropathol 124：627-641, 2012

12) Sivák Š, Kantorová E, Kurča E, Marcinek J, Slávik P, Michalik J, Nosál V：Primary diffuse leptomeningeal gliomatosis as a rare cause of pain in cervical spine. BMC Cancer 16：182, 2016

13) Tauziede-Espariat A, Maues de Paula A, Pages M, Laquerriere A, Caietta E, Delpont B, Viennet G, Medeiros de Bustos E, Moulin T, Barnerias C, Vauleon E, Grill J, Chiforeanu D, Vasiljevic A, Varlet P：Primary leptomeningeal gliomatosis in children and adults：a morphological and molecular comparative study with literature review. Neurosurgery 78：343-352, 2016

14) Schniederjan MJ, Alghamdi S, Castellano-Sanchez A, Mazewski C, Brahma B, Brat DJ, Brathwaite CD, Janss AJ：Diffuse leptomeningeal neuroepithelial tumor：9 pediatric cases with chromosome 1p/19q deletion status and IDH1（R132H）immunohistochemistry. Am J Surg Pathol 37：763-771, 2013

15) Schwetye KE, Kansagra AP, McEachern J, Schmidt RE, Gauvain K, Dahiya S：Unusual high-grade features in pediatric diffuse leptomeningeal glioneuronal tumor：comparison with a typical low-grade example. Hum Pathol 70：105-112, 2017

16) Yamasaki T, Sakai N, Shinmura K, Kawaji H, Koizumi S, Samashima T, Namba H：Anaplastic changes of diffuse leptomeningeal glioneuronal tumor with polar spongioblastoma pattern. Brain Tumor Pathol 35：209-216, 2018

17) Lee JK, Ko HC, Choi JG, Lee YS, Son BC：A case of diffuse leptomeningeal glioneuronal tumor misdiagnosed as chronic tuberculous meningitis without brain biopsy. Case Rep Neurol Med 2018：1391943, 2018　doi：10.1155/2018/1391943

18) Kang JH, Buckley AF, Nagpal S, Fischbein N, Peters KB：A diffuse leptomeningeal glioneuronal tumor without diffuse leptomeningeal involvement：detailed molecular and clinical characterization. J Neuropathol Exp Neurol 77：751-756, 2018

gene fusion and 1p deletion in disseminated oligodendroglioma-like leptomeningeal neoplasms（DOLN). Acta Neuropathol 129：609-610, 2015