輪状軟骨原発の喉頭軟骨肉腫の1例
軟骨肉腫は原発性骨悪性腫瘍の一つで骨盤や大腿骨などに多く，頭頸部領域に出現するものは稀である．今回輪状軟骨原発の喉頭軟骨肉腫症例を経験したため報告する．症例は87歳男性，2年前より持続する嗄声を主訴に受診した．上気道狭窄音と呼吸苦を認め，緊急気管切開術を施行し気道を確保した．内視鏡所見やCT/MRI所見から喉頭軟骨肉腫が疑われ，生検の組織所見では軟骨肉腫Grade Iを筆頭に内軟骨腫も鑑別に挙がった．輪状軟骨を中心に骨破壊性変化を伴う画像所見から悪性の可能性が高いと判断し，喉頭全摘出術，右頸部郭清術，甲状腺右葉切除術を施行した．切除後の病理組織精査により，軟骨肉腫Grade Iの診断を得た．軟...
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| Published in | 耳鼻咽喉科展望 Vol. 66; no. 5; pp. 224 - 229 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
耳鼻咽喉科展望会
15.10.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9687 1883-6429 |
| DOI | 10.11453/orltokyo.66.5_224 |
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| Abstract | 軟骨肉腫は原発性骨悪性腫瘍の一つで骨盤や大腿骨などに多く，頭頸部領域に出現するものは稀である．今回輪状軟骨原発の喉頭軟骨肉腫症例を経験したため報告する．症例は87歳男性，2年前より持続する嗄声を主訴に受診した．上気道狭窄音と呼吸苦を認め，緊急気管切開術を施行し気道を確保した．内視鏡所見やCT/MRI所見から喉頭軟骨肉腫が疑われ，生検の組織所見では軟骨肉腫Grade Iを筆頭に内軟骨腫も鑑別に挙がった．輪状軟骨を中心に骨破壊性変化を伴う画像所見から悪性の可能性が高いと判断し，喉頭全摘出術，右頸部郭清術，甲状腺右葉切除術を施行した．切除後の病理組織精査により，軟骨肉腫Grade Iの診断を得た．軟骨肉腫Grade Iは発生部位によっては掻爬術も考慮されるが，喉頭軟骨原発の症例では腫瘍の大きさや部位により，治療方針を慎重に検討する必要がある．喉頭軟骨原発の軟骨肉腫は症例が少なく，明確な治療基準は存在しない．そのため，症例に応じて適切な治療方針を吟味し決定していく必要がある． |
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| AbstractList | 軟骨肉腫は原発性骨悪性腫瘍の一つで骨盤や大腿骨などに多く，頭頸部領域に出現するものは稀である．今回輪状軟骨原発の喉頭軟骨肉腫症例を経験したため報告する．症例は87歳男性，2年前より持続する嗄声を主訴に受診した．上気道狭窄音と呼吸苦を認め，緊急気管切開術を施行し気道を確保した．内視鏡所見やCT/MRI所見から喉頭軟骨肉腫が疑われ，生検の組織所見では軟骨肉腫Grade Iを筆頭に内軟骨腫も鑑別に挙がった．輪状軟骨を中心に骨破壊性変化を伴う画像所見から悪性の可能性が高いと判断し，喉頭全摘出術，右頸部郭清術，甲状腺右葉切除術を施行した．切除後の病理組織精査により，軟骨肉腫Grade Iの診断を得た．軟骨肉腫Grade Iは発生部位によっては掻爬術も考慮されるが，喉頭軟骨原発の症例では腫瘍の大きさや部位により，治療方針を慎重に検討する必要がある．喉頭軟骨原発の軟骨肉腫は症例が少なく，明確な治療基準は存在しない．そのため，症例に応じて適切な治療方針を吟味し決定していく必要がある． |
| Author | 宮澤, 渉 森下, 幸太郎 土田, 敬介 結束, 寿 水上, 準也 高石, 慎也 弦本, 惟郎 中山, 潤 水成, 陽介 大谷, 晃嗣 小林, 俊樹 |
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| References | 3) 松村忠紀，山下敏彦，長谷川匡：軟骨肉腫の悪性度．病理と臨 27: 126–131, 2009. 5) Thompson LD, Gannon FH: Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol 26: 836–851, 2002. 9) Evans HL, Ayala AG, Romsdahl MM: Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histolioogic grading. Cancer 40: 818–831, 1977. 16) Lee FY, Mankin HJ, Fondren G, et al: Chondrosarcoma of bone: an assessment outcome. J Bone Joint Surg Am 81: 326–338, 1999. 4) Thompson LD, Gannon FH: Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol 26: 836–851, 2002. 15) Gelderblom H, Hogendoorn PC, Dijkstra SD, et al: The clinical approach towards chondrosarcoma. Oncologist 13: 320–329, 2008. 19) 志村英二，飯野 孝，高橋昌寛，他：術後早期に肺，骨転移をきたし不幸な天気を辿った喉頭軟骨肉腫の1症例．耳展 55: 218–222, 2012. 12) Konishi E, Nakashima Y, Mano M, et al: Primary central chondrosarcoma of long bone, limb girdle and trunk: analysis of 174 cases by numerical scoring on histology. Pathol Int 65: 468–475, 2015. 11) Unni KK, Inwards CY, Bridge JA, et al: AFIP Atlas of Tumor Pathology, Series 4, Tumors of the Bones and Joints, AFIP, Washington DC, 2005. 18) Piazza C, Paderno A, Nicolai P: Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches. Curr Opin Otolaryngol Head Neck Surg 25: 93–100, 2017. 10) Unni KK, Inwards CY: Dahlin’s Bone Tumors (6th ed), Lippincott Williams & Wilkins, Philadelphia, 2010. 7) Chin OY, Dubal PM, Sheikh AB, et al: Laryngeal chondrosarcoma: a systematic review of 592 cases. Laryngoscope 127: 430–439, 2017. 14) Angelini A, Guerra G, Mavrogenis AF, et al: Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am 81: 326–338, 1999. 20) 浅井俊一，花澤豊行，櫻井利興，他：甲状軟骨に発生した軟骨肉腫の1症例．頭頸部癌 46: 390–396, 2020. 1) WHO Classification of Tumours (5th ed), Soft Tissue and Bone Tumours, IARC Press, Lyon, 2020. 13) Bjornsson J, McLeod RA, Unni KK, et al: Primary factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40: 818–831, 1977. 17) Angelini A, Guerra G, Mavrogenis AF, et al: Clinical outcome of central conventional chondrosarcoma. J Surg Oncol 106: 929–937, 2012. 8) Bovee JVMG, Hogendoorn PCW, Wunder JS, et al: Cartilage tumours and bone development: molecular pathology and possible therapeutic targets. Nat Rev Cancer 10: 481–488, 2010. 2) 日本整形外科学会骨軟部腫瘍委員会：平成28年度全国骨軟部腫瘍登録一覧表．国立がん研究センター，2017. 6) Dubal PM, Svider PF, Kanumuri VV, et al: Laryngeal chondrosarcoma: a population-based analysis. Laryngoscope 124: 1877–1881, 2014. |
| References_xml | – reference: 16) Lee FY, Mankin HJ, Fondren G, et al: Chondrosarcoma of bone: an assessment outcome. J Bone Joint Surg Am 81: 326–338, 1999. – reference: 15) Gelderblom H, Hogendoorn PC, Dijkstra SD, et al: The clinical approach towards chondrosarcoma. Oncologist 13: 320–329, 2008. – reference: 6) Dubal PM, Svider PF, Kanumuri VV, et al: Laryngeal chondrosarcoma: a population-based analysis. Laryngoscope 124: 1877–1881, 2014. – reference: 8) Bovee JVMG, Hogendoorn PCW, Wunder JS, et al: Cartilage tumours and bone development: molecular pathology and possible therapeutic targets. Nat Rev Cancer 10: 481–488, 2010. – reference: 1) WHO Classification of Tumours (5th ed), Soft Tissue and Bone Tumours, IARC Press, Lyon, 2020. – reference: 12) Konishi E, Nakashima Y, Mano M, et al: Primary central chondrosarcoma of long bone, limb girdle and trunk: analysis of 174 cases by numerical scoring on histology. Pathol Int 65: 468–475, 2015. – reference: 13) Bjornsson J, McLeod RA, Unni KK, et al: Primary factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40: 818–831, 1977. – reference: 19) 志村英二，飯野 孝，高橋昌寛，他：術後早期に肺，骨転移をきたし不幸な天気を辿った喉頭軟骨肉腫の1症例．耳展 55: 218–222, 2012. – reference: 20) 浅井俊一，花澤豊行，櫻井利興，他：甲状軟骨に発生した軟骨肉腫の1症例．頭頸部癌 46: 390–396, 2020. – reference: 18) Piazza C, Paderno A, Nicolai P: Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches. Curr Opin Otolaryngol Head Neck Surg 25: 93–100, 2017. – reference: 17) Angelini A, Guerra G, Mavrogenis AF, et al: Clinical outcome of central conventional chondrosarcoma. J Surg Oncol 106: 929–937, 2012. – reference: 2) 日本整形外科学会骨軟部腫瘍委員会：平成28年度全国骨軟部腫瘍登録一覧表．国立がん研究センター，2017. – reference: 10) Unni KK, Inwards CY: Dahlin’s Bone Tumors (6th ed), Lippincott Williams & Wilkins, Philadelphia, 2010. – reference: 4) Thompson LD, Gannon FH: Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol 26: 836–851, 2002. – reference: 5) Thompson LD, Gannon FH: Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol 26: 836–851, 2002. – reference: 3) 松村忠紀，山下敏彦，長谷川匡：軟骨肉腫の悪性度．病理と臨 27: 126–131, 2009. – reference: 7) Chin OY, Dubal PM, Sheikh AB, et al: Laryngeal chondrosarcoma: a systematic review of 592 cases. Laryngoscope 127: 430–439, 2017. – reference: 11) Unni KK, Inwards CY, Bridge JA, et al: AFIP Atlas of Tumor Pathology, Series 4, Tumors of the Bones and Joints, AFIP, Washington DC, 2005. – reference: 14) Angelini A, Guerra G, Mavrogenis AF, et al: Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am 81: 326–338, 1999. – reference: 9) Evans HL, Ayala AG, Romsdahl MM: Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histolioogic grading. Cancer 40: 818–831, 1977. |
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| Snippet | 軟骨肉腫は原発性骨悪性腫瘍の一つで骨盤や大腿骨などに多く，頭頸部領域に出現するものは稀である．今回輪状軟骨原発の喉頭軟骨肉腫症例を経験したため報告する．症... |
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| SubjectTerms | 喉頭全摘出術 喉頭軟骨肉腫 軟骨肉腫 |
| Title | 輪状軟骨原発の喉頭軟骨肉腫の1例 |
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