CTで発見された肺腺癌の2例 [in Japanese] EXPERIENCE WITH TWO CASES OF ADENOCARCINOMA OF THE LUNG DETECTED BY CT [in Japanese]
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CTにて発見された肺腺癌の2例を報告した.症例1は66歳男性,喀痰細胞診にてclass V腺癌を認めたが原発巣を発見できず,外来にて厳重な経過観察を行っていた. 3カ月後, CTにて5×3mm大の微小な腫瘍影を認め手術を施行し,腺癌との病理診断を得た.症例2は37歳女性で,血痰を主訴に受診.胸部CTにて8×8mm大の淡い腫瘍影を認め手術を施行し腺癌との病理診断を得た. 2例とも通常の単純X線写真には全く映らない淡く小さな腺癌であったが, CTが診断に有用であった.近年高速螺旋CTの登場により撮影時間は一人約15秒,被爆量も6分の1程度で胃の集団検診と同程度にまで下げられてきており,早期肺癌の発見率向上のためには将来CTを検診項目に取り入れる必要があると思われる.また,喀痰細胞診は中心型肺癌のみならず症例1のような末梢型の微小肺癌であっても陽性となる場合があるため, 1次スクリーニングには有益な検査であると言える.
Two cases of adenocarcinoma of the lung detected by CT are reported. In case 1, a 66-year-old man had been strictly followed up on an ambulant basis because no primary lesion was detected despite class V adenocarcinoma indicated in an exfoliative cytlogy of sputum. Three months later CT revealed a 5×3mm tumor shadow in the lung. The patient was operated on and the lesion was pathologically adenocarcinoma. In case 2, a 37-year-old woman was seen at the hospital because of bloody sputum. Chest CT revealed a faint tumor shadow with the size of 8×8mm in the lung. The patient was operated on and the excised tumor was pathologically adenocarcinoma.<br> Both cases showed a faint and small adenocarcinoma which were not entirely visualized by usual simple chest X-ray films, but were successfully diagnosed by CT. Recent increasing usage of helical CT has enabled us to take a picture in a shorter time of about 15 seconds per person and at a decreased X-ray exposure to about one sixth of the conventional one which are comparable to those in the masss screening of the stomach. In order to increase the detection rate of early lung cancer, CT should be further involved in the screening examinations. Furthermore, since exfoliative cytology of sputa can reveal positive response not only to central type lung cancers but also to peripheral minute lung cancers like case 1, it appears to be a useful test in the first screening.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 58(10), 2303-2306, 1997-10-25
Japan Surgical Association