神経芽細胞腫について

Abstract

Three case reports of neuroblastoma primarily originated fro m the adrenal medulla and sympathetic ganglion and stastical survey of neuroblastoma in the Japanese literatures a re made. Case 1....A boy, 3 years and 7 months of age, admitted to hospital with chief complaints of abdominal distention, disorder of walking and exophthalmus. On IVP bilater a l hydronephrosis, lateral displacement of the ureters and tumor with calcification were foun d in the middle of the retroperitoneum (Fig. 1). Surgical extripation of the tumor was unsuccess ful and subsequent autopsy revealed sympathicoblastoma originated from the retro p eritoneal sympathetic ganglion and sympathicogonioma was partly mixded in the tumor ( Fig. 2, 3) with metastasis to the liver, spleen, kidneys, lymphnodes and bones. Case 2....A boy, 3 years and one month of age (Fig . 4), with chief complaints of abdominal distention, disorder of walking, left exophthalmus (Fig. 5) and anemia. O n IVP the kidney and ureters were displaced lateral (Fig. 7). A part of the retoroperito neal tumor was resected. Postoperatively palliative therapies of direct injection of radioisotope p82, 400 mc with total 1600 mc to the cranial bone metastasis, administration of nitrogen masturd 150 mgm, nitromine 400 mgm followed by X-Ray therapy were instituted without successful results and patient eventvally died. Postmortem findings revealed sympathicogonioma originating from the adrenal medulla (Fig. 8 & 9) with metastasis to the bilateral kidneys, bones and lymphnodes. Case 3....A male, 20 years an d 1 month of age, with chief complaints of dull pain in the left abdomen. Patient was oprated with a diagnosis of the left renal tumor acording to pyelogram and translumbar aortogram (Fig. 10). Sympathicoblastoma originated from the left adrenal medulla was found on surgery and the patient died 3 weeks postoperatively. On review of the Japanese literatures of neuroblastoma : 1) Age (Table 3) Those ages were less than 3 years were more than 50% of the total 177 cases and 70% of the total were found in those children who were less than 5 years of age. Eighty five percent of sympathicogonioma were found in those children who were less than 10 years of age and sympathicoblastoma were found in 76% of this age group. Tow hatients, 73 years of age, with sympathicogonioma were the oldest. 2) Sex (Table 4) : Fifty six percent of the total cases were found in m ale. 3) Primary origins (Table 5). 4) Metastasis of the tumor (Table 6 and 7). 5) On clinical observations, the main stress has been put on differential diagnosis with Wilms' tumor in the respects of chief complaint and diagnosis and the effect of local injection of radioisotope in tratmnt of neuroblastoma has been discussed.