衛藤 英理子, 牧 尉太, 玉田 祥子, 江口 武志, 光井 崇, 平野 友美加, 髙原 悦子, 早田 桂, 増山 寿, 平松 祐司

Eriko ETO, Jyota MAKI, Syoko TAMADA, Takeshi EGUCHI, Takashi MITSUI, Yumika HIRANO, Etsuko TAKAHARA, Kei HAYATA, Hisashi MASUYAMA, Yuji HIRAMATSU

岡山大学大学院医歯薬学総合研究科産科・婦人科学教室

Department of Obstetrics & Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.

キーワード : fetal cardiac tumor, tuberous sclerosis, rhabdomyoma

稀な疾患である胎児心臓腫瘍を3例経験したので報告する．症例1は30歳の経産婦で，妊娠38週0日に当院へ紹介となった．胎児超音波検査では心室中隔から左心室内に径13 mm大の高輝度腫瘤を認め一部が左室流出路に突出していた．妊娠39週1日3,966 gの男児を経腟分娩した．日齢1に腫瘍切除術を行い組織診断は横紋筋腫であった．生後2ヵ月半の頭部MRI検査で結節性硬化症と診断され，てんかんを合併している．5歳の時点で腫瘍の再発は認めていない．症例2は30歳の経産婦で，妊娠29週5日に当院へ紹介となった．胎児超音波検査では左心室内，右心室内，右心房内にそれぞれ径14 mm，17 mm，5 mm大の高輝度腫瘤を認めた．妊娠39週5日2,866 gの女児を経腟分娩した．生後日齢3の頭部CT検査で結節性硬化症と診断され，てんかんを合併している．3歳の時点で腫瘍は不変である．症例3は36歳の初産婦で，妊娠19週5日当院へ紹介となった．胎児超音波検査では左心室内に径10 mm大の高輝度腫瘤を認めた．妊娠37週4日に3,006 gの女児を経腟分娩した．日齢13に心室頻拍を認め抗不整脈薬で治療を開始した．9ヵ月の時点で腫瘍は不変である．胎児心臓腫瘍の予後不良因子は腫瘍径20 mm以上，胎児不整脈，胎児水腫といわれている．胎児診断の重要性を再認識するとともに，更なる予後因子の検討のためにも症例を蓄積することは意義深い．

We present three rare cases of fetal cardiac tumor. Case 1: A 30-year-old multipara was referred to our hospital at 38 weeks pregnant. Fetal ultrasonographic examination revealed a homogeneous, hyperechogenic tumor in the left ventricle (13 mm in diameter). A part of the tumor protruded into the ascending aorta. A male neonate (gestational age 39 weeks and 1 day, weight 3,966 g) was born via vaginal delivery. Tumor resection was performed at the age of 1 day, and the histopathological diagnosis was rhabdomyoma. Brain MRI confirmed tuberous sclerosis at the age of two and a half months. He had epilepsy. The tumor has not recurred as of age 5 years. Case 2: A 30-year-old multipara was referred to our hospital at 29 weeks and 5 days pregnant because of three homogeneous, hyperechogenic tumors in the fetal left ventricle, right ventricle, and right atrium (14 mm, 17 mm, and 5 mm in diameter, respectively). A female neonate (gestational age 39 weeks and 5 days, weight 2,866 g) was born via vaginal delivery. She was diagnosed with tuberous sclerosis by brain CT at the age of 3 days. She had epilepsy. The sizes of the tumors have not changed as of age 3 years. Case 3: A 36-year-old primipara was referred to our hospital at 19 weeks and 5 days pregnant because of a homogeneous, hyperechogenic tumor in the fetal left ventricle (10 mm in diameter). A female neonate (gestational age 37 weeks 4 days, weight 3,006 g) was born via vaginal delivery. Ventricular tachycardia appeared at the age of 13 days. The size of the tumor has not changed as of age 9 months. Factors for poor prognosis of fetal cardiac tumor include tumor size of 20 mm or larger, fetal arrhythmia, and hydrops fetalis. This study contributes to the further investigation of prognostic factors.