仙骨前部Dermoid cystの1例

Abstract

39歳男性.患者は下腹部痛を主訴に受診となった.WBC増多, 軽度の肝障害, 高血糖を認め, CTでは前立腺後部から直腸右側にかけて嚢胞状腫瘍を認め, 頭側は精嚢腺, 尾側は坐骨結節レベルまで存在し, 一部に隔壁および壁肥厚を認めた.経直腸超音波では前立腺右側に内部均一な点状エコーの腫瘤を, MRIでは腫瘍内容はT1強調像でlow, T2強調像でiso～high densityであった.治療は抗生剤投与で下腹部痛は軽快し, WBCも改善した.更に経仙骨アプローチでは仙骨前部の嚢胞状腫瘍摘出術を施行し, 迅速病理診断でdermoid cystと診断され, 腫瘍のみの摘出を行っ髪成分が主体で, 嚢胞壁は汗腺を含む角化扁平上皮, 筋層構造で形成され, 異型細胞は認めずdermoid cystと診断された.保存的治療で治癒し, 現在外来経過観察中である

A case report of a presacral dermoid cyst in an adult. A 39-year-old man visited our hospital because of lower abdominal pain. A soft mass was palpable on the right side wall of rectum. Computed tomographic (CT) scan, transrectal ultrasonography and MR imaging showed presacral cystic tumor with a diameter of 10 cm. The tumor was resected by using a sacral approach. It contained muddy substance and hairs. Histopathological examination showed that the tumor wall was made of stratified squamous epithelium with skin appendage. Hence, it was diagnosed as a dermoid cyst. After operation, wound infection and dehiscence occurred, but it healed after conservative treatment. Complete excision of developmental cysts is advised because of possibility of malignancy and infection.