松果体部腫瘍の既往を有するHCG産生性馬尾神経腫瘍の1例

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A 14-year-old male who had been previously treated by ventriculoperitoneal (VP) shunting and irradiation for a pineal tumor subsequently developed a human chorionic gonadotropin (HCG)- producing tumor of the cauda equina. Three years after the VP shunting procedure he developed progressive right lower monoparesis and sacral pain. On myelography and metrizamide computed tomography myelography a movable, solitary mass 3 cm in diameter with complete block was found in the cauda equina. A L2-L4 laminectomy, performed with the patient in the prone position, revealed a dark red tumor with a thin connective capsule infiltrating into the right fourth lumbar nerve. The tumor was totally removed, along with the nerve root. Histological inspection showed the tumor to be a germinoma having a seminoma-like appearance and containing syncytiotropho-blastic giant cells. The HCG and HCG-β subunit titers were high, especially in the cerebrospinal fluid, serum, and tumor tissue, whereas alpha-fetoprotein and carcinoembryonic antigen were negative. HCG and HCG-β in serum and cerebrospinal fluid decreased to normal following chemo-therapy. Solitary spinal metastases should be surgically removed. Irradiation and chemotherapy may also be effective against malignant HCG-β-producing tumors.
日本脳神経外科学会の論文
1987-12-15