眼窩内孤立性線維腫に対して術前動脈塞栓を併施し外切開による摘出を行った１例

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1 : WHO World Health Organization : solitary fibrous tumor WHO World Health Organization : : : : : CT 38mm

2 CT 3 MRI :T1 :T2 : T1 T1 T2 38mm MRI T1 T2 : 5mm HE CD34 CD99 SMA desmin cytokeratin MIB 1 solitary fibrous tumor MRI MX TM

3 :HE :HE :CD34 :CD99 :MIB 1 : : :CD34 :CD99 :MIB 1 5

4 図6 図7 岸本他眼窩内孤立性線維腫術中写真図先に摘出された検体の病理所見 HE 染色１０右頬部の横切開によりアプローチし腫瘍を被膜腫瘍と涙小管はわずかな線維組織両矢印を介と眼窩骨膜の間に沿って剥離し摘出したして近接していた摘出検体写真図9 追加摘出検体の病理所見 HE 染色１０ａ : 先に摘出された腫瘍の主病変鼻涙管組織は炎症細胞の浸潤と扁平上皮化生を伴ｂ : 主病変切除後に摘出された鼻涙管方向へのう慢性炎症の像を呈していたまた鼻涙管壁の線伸展病変めなかった同浸潤部と非浸潤部とで MIB 1 値に差異維性肥厚も認めた両矢印考察はなく有糸分裂像は 1/10 high power fields であり強本症例は問診上病変の増大は緩やかであり画像検い細胞増殖性は示唆されなかったまた腫瘍と涙小管と査上も周囲臓器への浸潤傾向を示す所見は乏しかったたは薄い線維組織を介して近接していた図８さらにめ悪性を示唆する所見は乏しいといえるただ全摘鼻涙管方向へ伸展していると判断され追加摘出した検体出を必要としない悪性リンパ腫の鑑別や組織型によっにおいて腫瘍は存在せず壁の線維性肥厚を伴う鼻涙管ては視機能を犠牲にする手術を考慮する必要があるた組織が認められた図９術後の急激な眼位の変化にめ正確な治療前診断が重要と考え摘出術を計画するよる複視は出現せず術後３カ月の時点で明らかな再発前に生検を施行した病変は右頬部皮下の浅層にまで存を認めていない在していたため比較的侵襲の低い手技により診断を確定させることができた孤立性線維腫の病理組織学的所見は太い膠原線維を

病変の増大は緩やかであり画像検い細胞増殖性は示唆されなかったまた腫瘍と涙小管と査上も周囲臓器への浸潤傾向を示す所見は乏しかったたは薄い線維組織を介して近接していた図８さらにめ悪性を示唆する所見は乏しいといえるただ全摘鼻涙管方向へ伸展していると判断され追加摘出した検体出を必要としない悪性リンパ腫の鑑別や組織型によっにおいて腫瘍は存在せず

5 HE vimentin CD34 Bcl 2 CD99 cytokeratins EMA SMA S 100 protein desmin CD34 HE MRI WHO MIB 1 MIB 1 Krishnakumar S, Subramanian N, Mohan ER, et al : Solitary fibrous tumor of the orbit : a clinicopathologic study of six cases with review of the literature. Surv Ophthalmol 2003 ; 48 : Leoncini G, Maio V, Puccioni M, et al : Orbital solitary fibrous tumor : a case report and review of the literature. Pathol Oncol Res 2008 ; 14 : Ali SZ, Hoon V, Hoda S, et al : Solitary fibrous tumor. A cytologic histologic study with clinical, radiologic, and

6 immunohistochemical correlations. Cancer 1997 ; 81 : Chan JK : Solitary fibrous tumour everywhere, and a diagnosis in vogue. Histopathology 1997 ; 31 : Kim TA, Brunberg JA, Pearson JP, et al : Solitary fibrous tumor of the paranasal sinuses : CT and MR appearance. AJNR Am J Neuroradiol 1996 ; 17 : Weiss B, Horton DA : Preoperative embolization of a massive solitary fibrous tumor of the pleura. Ann Thorac Surg 2002 ; 73 : Guo J, Chu X, Sun YE, et al : Giant solitary fibrous tumor of the pleura : an analysis of five patients. World J Surg 2010 ; 34 : Ing EB, Kennerdell JS, Olson PR, et al : Solitary fibrous tumor of the orbit. Ophthal Plast Reconstr Surg 1998 ; 14 : Woo KI, Suh YL, Kim YD : Solitary fibrous tumor of the lacrimal sac. Ophthal Plast Reconstr Surg 1999 ; 15 : Rumelt S, Kassif Y, Cohen I, et al : A rare solitary fibrous tumour of the lacrimal sac presenting as acquired nasolacrimal duct obstruction. Eye 2003 ; 17 : Schellini SA, Hoyama E, Marques ME, et al : Orbital solitary fibrous tumor : report of two cases and literature review. Jpn J Ophthalmol 2003 ; 47 : Bernardini FP, de Conciliis C, Schneider S, et al : Solitary fibrous tumor of the orbit : is it rare? Report of a case series and review of the literature. Ophthalmology 2003 ; 110 : A Case of Intraorbital Solitary Fibrous Tumor Resected Successfully with Preoperative Arterial Embolization Ippei Kishimoto, M.D., Shogo Shinohara, M.D., Keizo Fujiwara, M.D. Masahiro Kikuchi, M.D., Risa Tona, M.D., Yuji Kanazawa, M.D. Hiroyuki Harada, M.D., Yasushi Naito, M.D. and Yu Usami, M.D. Department of Otolaryngology Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe Department of Otolaryngology, Institute of Biochemical Research and Innovation, Kobe Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe The solitary fibrous tumor SFT is a rare spindle cell neoplasm derived from mesenchymal cells. It sometimes recurs clinically, and is categorized as an intermediate malignancy tumor under the WHO World Health Organization classification of soft tissue tumors. Several studies have reported on intraorbital SFTs, but none of them has pointed out the utility of preoperative arterial embolization in the case of an intraorbital SFT. A 75 year old man, who had received a dacryocystectomy for a benign tumor in the right lacrimal sac 30 years previously, visited our hospital complaining of lower eyelid swelling and lachrymation that had persisted for a year. CT and MRI revealed an intraorbital lesion, and the open biopsy specimen showed dense growth of spindle cells, which turned out to be an SFT by immunohistochemistry based on the findings. After preoperative embolization of the infraorbital artery, we removed the tumor with a skin incision on the lower rim of the orbit with little bleeding. The surgical specimen revealed that the tumor was close to a lacrimal canaliculus, which suggested the tumor originated from the lacrimal apparatus considering the patient s past history. He was followed up for three months without recurrences. Keywords : solitary fibrous tumor, intraorbital, preoperative arterial embolization, lacrimal sac, nasolacrimal duct Nippon Jibiinkoka Gakkai Kaiho Tokyo 117 : , 2014

Weiss B, Horton DA : Preoperative embolization of a massive solitary fibrous tumor of the pleura. Ann Thorac Surg 2002 ; 73 : 983 985.

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