鞍上部ムコール肉芽腫の1治験例

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A 14-year-old boy who had had a ventriculo-peritoneal shunt procedure for the post-meningitic hydrocephalus at the age of 12 was admitted with a left ophthalmoplegia in 1980. On admission, he had a low grade fever and leucocytosis but the causative agent was not identified by cerebrospinal fluid culture. Computerized tomography (CT) revealed presence of a slight high-density area in the suprasellar region with diffuse enhancement which led to diagnosis of suprasellar germinoma. Ir-radiation of 2,000 rads, however, did not produce any marked changes in CT. Because of severe liver dysfunction, a direct operation was postponed. About 30 months later, he was re-admitted in a drowsy state due to shunt dysfunction. CT disclosed that the left foramen of Monro was obstructed by a suprasellar tumor. Intracapsular removal of the tumor through a left frontal craniotomy was performed. Pathological diagnosis was granuloma and numerous fungus hyphae were found in the central part of the necrotic tissue. Periodic acid-Schiff staining showed non-septate fungi which were interpreted as mucormycetes. Postoperative examination of the other organs including the paranasal cavity did not show any abnormality. Following the administration of amphotericin B and 5-fluorocytosine, the patient recovered and was discharged. Cerebral mucormycosis often causes occlusion of large cerebral vessels by hyphae formation and also causes massive cerebral hemorrhages. Cerebral mucormycosis is one of the most fulminant types of fungal infections and the chronic type with granulation observed in this case is a very rare phenomenon. The authors discuss the significance of the serial CT findings and the importance of anti-fungal drug administration.
日本脳神経外科学会の論文
1984-12-15

鞍上部ムコール肉芽腫の1治験例

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