小細胞肺癌治療後に発生した同一肺葉内病変が分類不能癌と診断された1例

【背景】小細胞肺癌治療後の同一肺葉内病変を切除し分類不能癌と診断された1例を報告する.【症例】60歳代の男性.右肺下葉S8原発の小細胞肺癌Stage III A(T1bN2M0)に対して放射線化学療法が行われ,完全寛解となった.2年後に同一肺葉のS10に腫瘤が出現し,16ヵ月間にわたって化学療法が行われた.縮小と増大を繰り返し,最終的に治療抵抗性となったため当科紹介となった.右肺下葉S10に25×25mm大の腫瘍性病変を認めた.縦隔･肺門リンパ節や遠隔臓器への転移を疑う所見はなかった.小細胞肺癌の同一肺葉内再発と考えられるが,化学療法抵抗性で他に有効な治療法がないことから右下葉切除術ND2a-1を施行した.病理検査で分類不能癌と診断された.術後29ヵ月の現在,再発を認めない.【結論】小細胞肺癌に対する内科的治療抵抗性となった時点で救済手術を意図して右下葉切除術を行ったが,病理診断は分類不能癌であった.第2癌または再発の両観点から考察する.【Background】We report a case of unclassified lung carcinoma diagnosed after the treatment for small cell lung carcinoma.【Case】The patient is a man of 60 years old. The patient was treated with systemic chemoradiotherapy for small cell lung carcinoma developed in the right lower lobe S8(T1bN2M0).Regardless of achieving complete remission, the patient developed metachronous solitary lung nodule in the same lobe(S10).The nodule could be controlled for 16 months by chemotherapy against small cell carcinoma. Because the nodule became to be chemotherapy-resistant, the patient underwent surgery. Postoperative pathological examination revealed features of being unclassified carcinoma of the lung. The patient is aliving without recurrence 29 months after the operation.【Conclusion】Although it remains unknown whether the secondary lung lesion is metastatic or second primary lesion, surgery played a role as a curative intent treatment

神経内分泌的形態をもつ大細胞癌と腺扁平上皮癌からなる異時性多発肺癌の1例

背 景:原発性肺癌の組織型でadenosquamous carcinoma(Adsq)とlarge cell carcinoma with neuroendocrine morphology(LCCNM)はともに頻度が少なく,それらを異時性に合併した症例の報告は認められない.症 例:80歳の男性.65歳時に喉頭癌で,喉頭全摘術が行われた.喉頭癌の術前CTで右肺中葉と下葉に結節を認められていたため,肺部分切除が行われたが,結果は良性結節であった.その7年後,右肺上葉と中葉と下葉のそれぞれに計3個の肺結節が認められ,喉頭癌の転移が疑われ,肺部分切除が行われたが,すべてがLCCNMであり,LCCNMの他肺葉転移の可能性が高いと診断された.さらに3年後,右肺上葉に再び結節が認められたため,肺部分切除が行われたが,今度はAdsqであった.その5年後に右肺下葉に結節影が認められ,4度目の手術が行われた.病理結果はAdsqであった.結 論:LCCNMとAdsqからなる稀な異時性多発肺癌を複数回の胸腔鏡下手術(VATS)を含む集学的治療により長期生存が得られた.Background:Adenosquamous carcinoma(Adsq)and large cell carcinoma with neuroendocrine morphology(LCCNM)are rare histologic types of primary lung cancer. The metachronous occurrence of these types has not been reported previously in Japan. Case:A man in 80s had undergone whole larynx enucleation for laryngeal cancer when he was in 60s. Partial lung resection was performed because a nodular shadow was detected in the middle and lower lobes of the right lung on chest computed tomography(CT)before the laryngeal surgery, but the nodules were found to be benign. Seven years later, CT showed a nodular shadow in all lobes of the right lung. On suspicion of metastatic laryngeal cancer, partial lung resection was performed. However, all the nodules were histopathologically diagnosed with LCCNM. Three years thereafter, partial lung resection was performed again because of a nodular shadow in the upper lobe of the right lung on CT. The nodule was histopathologically classified as Adsq. Five years later, a fourth lung operation was performed because of a nodular shadow in the lower lobe of the right lung on CT, which was diagnosed as Adsq.Conclusion:We report a rare case who got long-term survival by lung operation of metachronous multiple lung cancers with LCCNM and Adsq