当科で経験した側頭骨線維性骨異形成症の1例

線維性骨異形成症は,骨の吸収,未熟な骨梁の新生を主病変とし,骨の形成異常を原因とする非腫瘍性骨疾患であり,四肢の長管骨,肋骨,頭蓋顔面骨に好発し,頭蓋顔面骨では上顎骨,下顎骨の報告はしばしば散見されるが,側頭骨発生の頻度は少ない.今回,我々は側頭骨に生じた線維性骨異形成症の1例を経験したので文献的考察を加え報告する.症例は53歳男性.20XX年4月初旬,左耳痛・耳漏を主訴に近医を受診し,急性中耳炎と診断され治療を行われるも改善乏しく,5月中旬紹介となった.初診時,外耳道,鼓膜所見に異常は認めず,純音聴力検査では軽度の気導-骨導差を認め左混合難聴であった.CT所見で左外耳道,鼓室内には軟部陰影は認めなかったが,左乳突蜂巣内に側頭骨の菲薄化,破壊像を認め,周囲にスリガラス陰影を呈する比較的低吸収域の軟部陰影を認めた,またMRI所見では,左乳突蜂巣内に,T1強調像で小脳実質と等信号であり,周囲に造影効果を認め,T2強調像で周囲が高信号な辺縁整で境界明瞭な腫瘤性病変を認めた.これらから,組織学的検査目的で手術を行った.左耳後切開し,外耳道を剥離し,鼓室・上鼓室を明視下に置き,中耳腔全体を観察した.鼓膜は正常であったが,ツチ-キヌタ骨関節に軽度な肉芽組織を認めたが,アブミ骨の可動性は良好であった.乳突洞削開術を行うと,骨は脆弱でもろく,乳突蜂巣に肉芽病変が充満し,乳様突起先端部に直径1cm以下の嚢胞病変を認めた.術中側頭骨及び,嚢胞を病理検査に提出した.中頭蓋底およびS状静脈洞の骨膜が広範囲に破壊されており,この部位に,筋膜および骨を置き,手術終了した.病理組織検査では,形状が不整で骨芽細胞や破骨細胞をほとんど認めない未熟な骨を認め,周囲に間質の疎な線維性結合組織の増殖があった事から線維性骨異形成症と診断した.現在術後12か月になるが,再発なく経過良好である.Fibrous dysplasia(FD) is a benign disease characterized by the progressive replacement of the normal bone element with fibrous tissue. FD is usually found in the long bones, and is rare in the temporal bone. Surgery may be necessary for restoration of conductive hearing loss and prevention of complications. Meatoplasty has often been selected as surgical treatment, and the postoperative restenosis of external auditory canal(EAC) was found in most cases requiring management to prevent restenosis of EAC. Although FD is a benign disease, often to come back or to return, it is nessesary for careful follow up. We report a case of monostotic FD of the temporal bone. The patient was a 53 years old man, who complained of repeatedly ear discharge in the left ear. He have diabetes and hypertension. When a patient is first seen, ear discharge and eardrum perforation is nothing, and otitis media cholesteatoma is not own. The hearing test is left sensorineural hearing impairment. Computed tomography revealed pagetoid and sclerotic changes of the temporal bone. Biopsy was performed and the histological examination diagnosed FD

Iliopsoas Abscess Possibly due to Klebsiella pneumoniae Infection after Chemoradiotherapy for Hypopharyngeal Cancer

Iliopsoas abscess was once an uncommon condition but now occurs somewhat more frequently due to the increasing number of immunocompromised patients, such as those with diabetes. We encountered a case of iliopsoas abscess following chemoradiotherapy for hypopharyngeal cancer. A 60-year-old man was admitted for a sore throat and left neck swelling. Hypopharyngeal cancer was diagnosed, but the patient refused surgery. After two rounds of chemotherapy, febrile neutropenia developed and chest computed tomography (CT) revealed an iliopsoas abscess. The platelet count was low but recovered after administration of antibiotics and could not be explained by puncture of the abscess. CT-guided drainage eventually improved his symptoms. Even for disorders of the head and neck region, iliopsoas abscess should be suspected in immunocompromised patients who develop a fever. CT and magnetic resonance imaging should be performed at an early stage as it is important to determine whether surgical drainage is indicated