肺門部リンパ節に単発転移を認めた原発性食道悪性黒色腫の1例  [in Japanese] A surgical case of isolated lymph node recurrence of primary malignant melanoma of the esophagus  [in Japanese]

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Abstract

症例は66歳女性,4年前に原発性食道悪性黒色腫と診断され,胸部食道切除ならびに術後補助化学療法(DAC-tam)を施行した.その後,外来で経過観察中の胸部CTで,左肺門部のリンパ節腫大とPET-CTで同部位に異常集積を認めた.5-S-cysteinyl dopaも上昇し,原発性食道悪性黒色腫のリンパ節転移が疑われ手術となった.完全内臓逆位であり,脈管の走行は左右鏡面像であった.腫大したリンパ節はV1,V3,A3の間に存在し,上葉とも接していた.病変を完全切除するためにV1,V3,A3を結紮切離した.また周囲の肺も一部合併切除した.病理所見は食道悪性黒色腫のリンパ節転移であった.術後補助化学療法(DTIC)を6コース施行し,10ヵ月たった現在,再発無く経過良好である.悪性黒色腫のリンパ節転移に対し,切除が可能であれば手術は有用であると考えられた.

A 66-year-old woman with complete situs inversus received a diagnosis of primary malignant melanoma of the esophagus (PMME) four years previously. She underwent esophagectomy and received adjuvant therapy (DAC-tam). During the postoperative follow-up, hilar lymph node enlargement of the left lung was detected by chest CT. PET-CT also showed an abnormal accumulation in the same lesion. We suspected the lymph node enlargement to be PMME recurrence, and performed lymphadenectomy for diagnosis and treatment. Regarding intraoperative findings, the structure of the pulmonary vasculature of the left lung was the same as of the right lung because of complete situs inversus. The enlarged lymph node was fixed to V1, V3, and A3. Therefore, we ligated and divided them to resect the lesion completely. The lymph node was diagnosed as metastasis of PMME, and she received adjuvant therapy (DTIC) after surgery. Now, ten months after surgery, she is alive and without any evidence of recurrence. This is the first reported case of resection to isolate lymph node recurrence of PMME.

Journal

  • The Journal of the Japanese Association for Chest Surgery

    The Journal of the Japanese Association for Chest Surgery 25(5), 509-512, 2011-07-15

    The Japanese Association for Chest Surgery

References:  13

Codes

  • NII Article ID (NAID)
    10029125712
  • NII NACSIS-CAT ID (NCID)
    AN10467885
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    09190945
  • Data Source
    CJP  J-STAGE 
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