肺癌に合併する非細菌性血栓性心内膜炎の特徴とその意義 Features and Significance of Nonbacterial Thrombotic Endocarditis in Patients with Lung Cancer
肺癌患者における非細菌性血栓性心内膜炎(nonbacterial thrombotic endocarditis:NBTE)の特徴の意義を調べるため, 肺癌剖検142例の臨床病理学的検討を行った.11例(7.7%)にNBTEを認め, 組識型別には腺癌62例中8例(13%), 扁平上皮癌35例中3例(8.6%)の順で, 小細胞癌(34例)にはNBTEの合併はみられなかった.一方142例中11例に病理学的に播種性血管内血液凝固(disseminated intravascular coagulation:DIC)がみられた.このうち4例(36%)はNBTE症例で, DICとNBTEとの間には有意の相関を認めた(p<0.01).NBTE11例中7例に全身の血栓塞栓症を認め, その部位は脾(7例), 脳(5例), 腎(4例), 心(3例), 腸間膜(2例)であった.多発性出血性脳梗塞(4例)はいずれも致命的で, 心筋梗塞や腸間膜動脈塞栓症による腹膜炎も死因となっていた.NBTEは肺癌に稀ならず合併し, それによる血栓塞栓症は予後を左右する事もあるため, 臨床医はNBTEの特徴と意義を熟知する必要がある.
To examine features and significance of nonbacterial thrombotic endocarditis (NBTE) in patients with lung cancer, we clinicopathologically reviewed 142 autopsied patients with lung cancer. Eleven (7.7%) of the patients had NBTE. Incidence of NBTE was 13% (8 / 62 cases) in adenocarcinoma and 8.6% (3 / 35 cases) in squamous cell carcinoma. None of the patients with small cell carcinoma (34 cases) had NBTE. Eleven of the 142 patients had pathologically proved disseminated intravascular coagulation (DIC), and 4 of the 11 patients (36%) also had NBTE. There was significant correlation between DIC and NBTE (p<0.01). Seven of the 11 patients with NBTE had systemic thromboembolism mostly accompanied by infarction. Organs with thromboembolism were as follows : spleen (7 cases), brain (5 cases), kidneys (4 cases), heart (3 cases), and mesentery (2 cases). Multiple, hemorrhagic cerebral infarction (4 cases) was fatal. Myocardial infarction and peritonitis caused by mesenteric arterial embolization also contributed to death. The present study revealed that NBTE occasionally occured in patients with lung cancer and that systemic thromboembolism due to NBTE affected prognosis of the patients. The authors stress that clinicians should keep in mind the features and significance of NBTE in treating patients with lung cancer.
肺癌 34(6), 843-852, 1994-10-20