目的：傍神経節腫（paraganglioma）は，副腎外褐色細胞腫ともいわれ，副腎外の交感神経系および副交感神経系の傍神経節から発生する腫瘍である．まれな腫瘍であり，超音波像を主体として検討を行った報告は少ない．今回我々は，傍神経節腫8病変の超音波像を検討したので報告する．
対象と方法：2001年8月～2014年3月までに当院にて超音波検査施行し，病理組織学的に傍神経節腫と診断された8症例，8病変を対象とした．内訳は，切除7病変，生検1病変，年齢は15～72歳（中央値36歳），性別は，男性4例，女性4例であった．
各病変の超音波検査における存在部位，大きさ，形状，境界，内部性状，カラードプラの所見について検討した．
結果と考察：8病変中7病変は後腹膜，1病変は腹腔内に存在した．後腹膜に存在した5病変および腹腔内に存在した1病変の計6病変（75%）は，下大静脈もしくは膵に接していた．大きさは，23～119 mm（中央値65 mm）．形状は，類球形6病変（75%），多角形1病変，不整形1病変であった．8病変全て境界明瞭（100%）であった．内部性状は，4病変（50%）は充実性腫瘍，4病変（50%）は囊胞状成分優位の腫瘍であった．血流信号を検出したものは，腫瘍内部に大きな囊胞状成分を認めた症例を除く7病変（88%）であった．由来臓器の特定を行うために，動的観察を駆使した．腫瘍の形状は，類球形が多く，全て境界明瞭を示した．また，内部に血流信号を検出する病変が多かった．存在部位とこれらの所見を合わせて診断する必要がある．内部に囊胞状成分を伴わない病変が4病変あり，囊胞状成分の有無のみで鑑別診断することは困難と考える．
結論：後腹膜に位置し，類球形，境界明瞭で血流豊富な腫瘍を認めた際は，傍神経節腫を念頭に診断を進める必要がある．
Purpose: A paraganglioma is a tumor that arises from the paraganglia of the extra-adrenal sympathetic and parasympathetic nervous systems, and it is also known as an extra-adrenal pheochromocytoma. It is a rare tumor that has only been reported in a few studies, primarily using ultrasonography. We present our findings from the study of the ultrasound images of eight paragangliomas.
Subjects and Methods: We examined eight lesions from eight patients who were histopathologically diagnosed with paraganglioma after undergoing ultrasonography at our hospital between August 2001 and March 2014. Resection was performed in seven lesions, and biopsy was performed in one lesion. Patients were aged 15–72 years (median, 36 years) and included four men and four women.
The location, size, shape, boundaries, internal properties, and color Doppler ultrasonography findings for each lesion were examined.
Results and Discussion: Seven of the eight lesions were located in the retroperitoneum, whereas the remaining lesion was located in the abdominal cavity. Six lesions were in contact with the inferior vena cava or pancreas. Lesion sizes ranged from 23 to 119 mm (median, 65 mm), and the lesion shape was near-spherical in six lesions (75%), polygonal in one, and irregular in one. All eight lesions (100%) had distinct boundaries. Internally, four lesions (50%) were solid tumors and four (50%) were tumors with predominantly cystic components. Blood flow signals were detected in seven lesions (88%), with the remaining lesion exhibiting large cystic components within the tumor.
The tumor was in contact with the inferior vena cava or pancreas in six of the eight lesions (75%). To identify the organ of origin, we used dynamic observation. The tumor shape was near-spherical in most cases, and all lesions showed distinct boundaries. Furthermore, blood flow signals were detected in many of the lesions. Therefore, the diagnosis of these lesions should take into account both the location and the abovementioned considerations. Four lesions contained no cystic components, suggesting that a definitive diagnosis is difficult based on the presence or absence of cystic components alone.
Conclusions: When near-spherical tumors with distinct boundaries and a rich blood flow are found in the retroperitoneum, paragangliomas should be considered during diagnosis.
キーワード：傍神経節腫；後腹膜；血流豊富；超音波
Key words: paraganglioma; retroperitoneum; a rich blood flow; ultrasound
© 2017 一般社団法人日本超音波検査学会© 2017 Japanese Society of Sonographers
This page was created on 2016-12-06T09:11:47.309+09:00
This page was last modified on 2017-01-31T10:24:37.700+09:00
このサイトは（株）国際文献社によって運用されています。
