肺嚢胞壁周囲に沿って浸潤増殖を示した肺腺癌の1手術例 [in Japanese] A Surgical Case of Lung Adenocarcinoma Invading and Proliferating along the Wall of a Lung Cyst [in Japanese]
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胸部X線写真にて腫瘤影を呈さず，肺嚢胞壁に沿って浸潤増殖した肺腺癌の1手術例を報告する。<br> 症例は65歳，男性。近医にて平成11年7月左下葉の肺嚢胞を指摘され，この1年間に2度肺胞内感染の既往があった。今回血痰が出現したため平成15年1月精査加療目的で当科に紹介された。胸部レントゲンでは左下葉に約60×50 mmの嚢胞を認め，平成11年の胸部レントゲン所見に比べその嚢胞は増大し，壁は不整に肥厚していた。気管支鏡検査にて左底幹気管支に血性分泌物の付着を認めたが，気管支の狭窄や粘膜の異常は見られなかった。左底幹気管支の洗浄液で細胞診が陽性であったため肺嚢胞に併発した肺癌を疑い，平成15年3月左下葉切除術を施行した。病理所見では嚢胞壁に沿って浸潤増殖した中等度分化型の乳頭状腺癌であり，胸部レントゲンで嚢胞壁の不整肥厚像をきたしたものと考えられた。肺嚢胞の経過観察中に壁肥厚が認められた場合には悪性疾患の合併を念頭に入れる必要がある。
We report a surgical case of lung adenocarcinoma that did not present as a mass shadow, but invaded and proliferated along the wall of a lung cyst.<br>The patient, a 65-year-old male, had a lung cyst in the left lower lobe which had been noted at a local clinic in July 1999, and had become infected twice in the past year. He was referred to our department in January 2003 because of hemosputum and for further evaluation and treatment. Chest X-ray showed an approximately 60×50 mm cyst in the left lower lobe. The cyst was enlarged relative to that seen on a chest X-ray taken in 1999, and the wall was irregularly thickened. Bronchoscopic examination revealed bloody secretions adhering to the left lower lobe basilar bronchial trunk without stenosis or mucosal abnormalities. Since cytological examination of lavage fluid of the left lower lobe basilar bronchial trunk was positive, lung cancer complicating a lung cyst was suspected, for which a left lower lobectomy was performed in March 2003. The pathological diagnosis was moderately differentiated papillary adenocarcinoma invading and proliferating along the wall of the lung cyst. The adenocarcinoma appeared to have presented as an irregularly thickened cyst wall on the chest X-ray. Thus, the finding of irregular wall thickening during a follow-up for a lung cyst should suggest the development of malignancy as a complication.
- The Journal of the Japan Broncho-esophagological Society
The Journal of the Japan Broncho-esophagological Society 57(3), 307-311, 2006-06-10
The Japan Broncho-esophagological Society