神経節神経腫の2例

Abstract

症例1は25歳男で, 心窩部痛を主訴とした.非機能性右副腎腫瘍の診断で, 右副腎摘出術を施行した.迅速病理検査にて良性筋脂肪腫の診断であった.索状の束となって分布するShwann細胞の増生と大型ganglion細胞からなる神経節神経腫の所見がえられ, 副腎原発神経節神経腫の診断となった.症例2は29歳男で, 無症候性顕微鏡的血尿を主訴とし, 腹部CT・MRIで左後腹膜腫瘍が認められた.非機能性左後腹膜腫瘍の診断にて摘出術を施行した.迅速病理検査にて神経節神経腫の診断がえられ, 左副腎の合併切除をした.病理により後腹膜原発神経節神経腫と診断された

Ganglioneuroma is relatively rare, and difficult to distinguish from other tumors due to lack of image findings specific for ganglioneuromas. In this report, two cases of ganglioneuroma preoperatively diagnosed as non-functioning adrenal tumor and retroperitoneal tumor are reported. A 25-year-old male and a 29-year-old male visited our institute with chief complaints of upper abdominal pain and asymptomatic microscopic hematuria, respectively. Computed tomographic scan and magnetic resonance imaging showed a 7 x 6 x 5 cm solid tumor above the upper pole of the right kidney in the former case, 8 cm poorly enhanced tumor grown surrounding the left renal artery in the latter case. Surgical resection was performed in both cases. In the latder case, since intraoperative histological examination showed no malignant finding, renal vessels penetrating in the tumor were preserved by transecting the tumor. Postoperative histological examination revealed an adrenal ganglioneuroma and a retroperitoneal ganglioneuroma in the former and latter cases, respectively. A ganglioneuroma can be surgically dissected with favorable prognosis, but preoperative differential diagnosis is sometimes difficult due to few specific radiological and laboratory findings.