酢酸リュープロレリン皮下注射により生じた類上皮肉芽腫の1例

Abstract

73歳男.主訴は酢酸リュープロレリン皮下注射後の両上腕皮下硬結, 腹部の潰瘍形成.皮下硬結の病理組織学的所見で皮下脂肪組織に膿瘍形成を認め, その周りに線維化があり, 周囲には類上皮細胞と多核巨細胞よりなる小型肉芽腫の集簇巣を認めた.肉芽腫周囲にはリンパ球, 形質細胞浸潤を認めた.このような小さな肉芽腫性病変は真皮深層から一部真皮浅層でも認められた.表皮には著変はなかった.多核巨細胞は, ランゲルハンス型巨細胞や異物型巨細胞が混在しており, 巨細胞の胞体内には, 大小の脂肪滴と思われる空胞が散見された.上腕外側硬結はデルモベート外用とハイドロサイトにより熱感, 腫脹が軽快した.潰瘍については, 壊死物のデブリードマン, 生理食塩水, ハイドロサイト及びオプサイト貼付により上皮化した.リュープリンSRから酢酸ゴセレリン製剤(Zoladex)に変更したが, 現在投与部位に皮下硬結は発生していない

A 73-year-old man presented with an ulcer and a subcutaneous nodule where he was receiving leuprorelin acetate injections to treat his prostatic carcinoma. Pathological findings of a skin biopsy showed many epithelioid granulomas with multinuclear giant cells, which contained small vacuoles. Recently, these lesions have been suggested to be caused by a type IV allergic response to the copolymer of lactic and glycolic acids used as a vehicle for drug administration. When urologists treat a prostatic adenocarcinoma with subcutaneous infusion of leuprorelin acetate, they should be aware of this potential side effect of the drug because the resulting granulomar formation may interfere with the effect of the drug. If patients suffer from subcutaneous nodules, urologists should consider changing the drug to an other type of luteinizing hormone-releasing hormone analogues such as goserelin acetate. This reaction to leuprorelin acetate has been reported in only seven cases including our case.