文献考察:後腹膜腫瘍
1)【泌尿器科画像診断】 疾患別画像診断 後腹膜腔疾患 後腹膜腫瘍(解説/特集)
Author:細木茂(大阪府立成人病センター研究所), 黒田昌男
Source:臨床泌尿器科(0385-2393)53巻4号 Page327-330(1999.04)
要旨:後腹膜腔は,副腎,腎,尿管,膀胱,血管,リンパ管,神経などの多くの器官を含み,この領域の腫瘍は発生母体同様に多彩な組織型を示す。悪性腫瘍が全体の70〜80%を占める.しかし,後腹膜悪性腫瘍は,癌全体からみれば0.1〜0.2%を占める稀な疾患である.大部分は40歳から60歳にかけて発生し,性差は認められない.横紋筋肉腫や神経芽細胞腫は小児期に生じやすく,神経原性腫瘍や奇形腫は30歳以前に生じやすい.頻度の高い悪性腫瘍は脂肪肉腫で,ついで平滑筋肉腫や悪性線維性組織球腫である。良性腫瘍では脂肪腫や神経線維腫や神経鞘腫がある.後腹膜腔原発の腫瘍は,表に示すように,発生母地から中胚葉性,神経原性,胎脆性および異所性に分類される.悪性腫瘍の予後は不良で,5年生存率は10〜15%である.
2)リンパ節転移を伴った後腹膜原発平滑筋肉腫の1例(原著論文/症例報告)
Author:永井盛太(山田赤十字病院 外科), 村林紘二, 赤坂義和, 楠田司, 宮原成樹, 高橋幸二
Source:日本臨床外科学会雑誌(1345-2843)63巻12号 Page3067-3071(2002.12) 本邦報告例53例の考察:年令は3〜83歳(平均56.5歳),男女比は16:37,平滑筋肉腫と術前診断されたものはUS下生検が施行された2例のみで,術前診断は困難である.腫瘍最大径は5cm以下が4例,5.1〜10cm:14例,10.1〜15cm:15例,15.1〜20cm:6例,20cm以上が7例である.治療は外科的切除が第一選択であり,一般的には有効な化学療法はない.進展様式は,肝転移と肺転移の血行性転移が多く,リンパ節転移は少ない.
参考文献
Radiographics. 2003 Jan-Feb;23(1):45-57. Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues.
Nishino M, Hayakawa K, Minami M, Yamamoto A, Ueda H, Takasu K.
Primary retroperitoneal neoplasms are a rare but diverse group of benign and malignant tumors that arise within the retroperitoneal space but outside the major organs in this space. Although computed tomography and magnetic resonance imaging can demonstrate important characteristics of these tumors, diagnosis is often challenging for radiologists. Diagnostic challenges include precise localization of the lesion, determination of the extent of invasion, and characterization of the specific pathologic type. The first step is to determine whether the tumor is located within the retroperitoneal space. Displacement of normal anatomic structures of the retroperitoneum is helpful in this regard. For tumors that are located within the retroperitoneum, the next step is to identify the organ of origin. Specific signs, including the "beak sign," the "embedded organ sign," and the "phantom (invisible) organ sign," are useful for this purpose. When there is no definite sign that suggests the organ of origin, the diagnosis of a primary retroperitoneal tumor becomes likely. Awareness of specific patterns of spread, specific tumor components, and tumor vascularity help in further narrowing the differential diagnosis. Attention to these diagnostic clues is essential in making an accurate radiologic diagnosis of primary retroperitoneal tumors and in obtaining clinically significant information. PMID: 12533639
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