超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 45(2): 145-154 (2020)
doi:10.11272/jss.296

原著Original Article

表在性神経線維腫の超音波検査所見の検討Evaluation of Ultrasonographic Appearance of Superficial Neurofibroma

1東海大学医学部付属病院臨床検査技術科Division of Laboratory Medical Technology, Tokai University Hospital

2東海大学医学部基盤診療学系病理診断学Department of Pathology, Tokai University School of Medicine

3東海大学医学部基盤診療学系臨床検査学Department of Laboratory Medicine, Tokai University School of Medicine

受付日:2019年3月30日Received: March 30, 2019
受理日:2019年11月11日Accepted: November 11, 2019
発行日:2020年4月1日Published: April 1, 2020
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目的:表在性の神経線維腫は発生部位や形態が多様であり,超音波検査上,鑑別診断として挙げることが困難な場合も多い.今回,超音波検査判定精度の向上を目的とし,後方視的に超音波検査所見の検討を行い,その分類と特徴的な所見の特定を試みた.

対象と方法:2006年1月から2014年12月の間に当院で超音波検査を施行し,病理組織学的に神経線維腫と確定診断された31症例39病変を対象とした.全病変について超音波検査所見(形状,境界,側方陰影,内部エコー,後方エコー,ダイナミックテストによる変形性の有無)の検討および病理組織標本との対比を行った.さらに,病変の形状と存在部位による分類(I~V型)を試みた.

結果:39病変は様々な形状を示し,存在部位によりI~V型に分類できた.そのうち腫瘤群は30病変(76.9%),非腫瘤群は9病変(23.1%)であった.頭頸部に発生するものが最も多く(13病変,33.3%),大きさは20 mm以下が6割を占めた.真皮内の低エコー腫瘤像で皮膚表面を持ち上げるように隆起するものが最も多かった(13病変,33.3%).内部に索状高エコーを認めるものが存在し(21病変,53.8%),特に真皮から皮下組織に病変が存在するタイプ(7病変)において,高頻度に索状高エコーが認められた(7病変中6病変,85.7%).Bモード上ダイナミックテストによる変形性の有無について評価を行った例では,全例が変形を認め軟らかい病変が示唆された.病理組織標本との対比の結果,超音波検査所見は,組織学的特徴を反映し多様であり,内部の索状高エコーは脂肪組織を反映していた.

結語:神経線維腫は多様な超音波検査所見を呈する.軟らかい表在性の低エコー病変で,内部に索状高エコーを認める場合は,神経線維腫を鑑別の一つに挙げる必要がある.

Purpose: It is difficult to establish a differential diagnosis from the ultrasonographic examination of superficial neurofibromas. Hence, this retrospective study was conducted to elucidate the characteristic features of the sonographic appearance of superficial neurofibromas.

Subjects and Methods: Thirty-one patients (39 lesions) underwent ultrasonographic and histopathological examinations at our university hospital within a period of eight years, from January 2006 to December 2014. The sonographic findings including shape, border, lateral shadow, internal echo, posterior echo, and deformation by the dynamic test were studied and compared with the histopathological findings. Furthermore, a classification based on the shape and location of occurrence were attempted.

Result and Discussion: Sonographic appearance of the lesions varied widely. The 39 lesions were classified into two major groups: mass formation (30/39 lesions; 76.9%) and non-mass formation (9/39 lesions; 23.1%) lesions. The lesions were most prevalent in the head and neck (13/39 lesions; 33.3%). The size of most lesions (60%) was less than 20 mm. They frequently presented with high internal echoes with funicular appearance (21/39 lesions; 53.8%). Particularly those lesions extending from the epidermal to subcutaneous tissues (7 lesions) more frequently presented with high internal echoes and a funicular appearance (6/7 lesions; 85.7%). The results of the dynamic test showed that all lesions were deformed, indicating that they were soft lesions. When these findings were compared with the histopathological findings, the funicular high internal echoes were found to be corresponding to the adipose tissue.

Conclusion: Neurofibromas have various sonographic appearances. When a soft superficial lesion with funicular high internal echo is observed, the tumor type of neurofibroma should be considered.

Key words: neurofibroma; ultrasonography; neurofibromatosis type1

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