気管・気管支に発生した腺様嚢胞癌切除例の臨床病理学的検討  [in Japanese] Clinicopathologic Study of Surgically Treated Cases of Tracheobronchial Adenoid Cystic Carcinoma  [in Japanese]

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Abstract

<b>目的</b>.気管・気管支原発の腺様嚢胞癌(ACC)手術症例につき検討した.<b>対象と方法</b>.切除標本でACCと病理診断された5例を対象とした.年齢は37~67(平均50.8)歳,全例女性であった.発生部位は中枢:4,末梢:1例であった.リンパ節転移はN2:1,N1:1,N0:3例で,病理病期はIA:1,IIB:2,IIIB:2例であった.術式は肺全摘:2,葉切:2,気管分岐部切除:1例で,気管・気管支形成術を3例に施行した.<b>結果</b>.N2例は袖状右肺全摘術後15ヶ月で遠隔転移により死亡した.N1例は袖状右中葉切除術後9年6ヶ月で局所再発し,残存右肺全摘術を施行,さらに4年10ヶ月健在である.N0例3例のうち末梢発生の1例は左上葉切除術後7年11ヶ月で他病死した.他のN0例は切除断端陽性例で,1例は気管分岐部切除・二連銃型再建術後に放射線療法を施行し12年健在,もう1例は左肺全摘術後に放射線療法を施行し10ヶ月健在である.<b>結論</b>.ACCは一般的にはslow growingであり,転移することはまれだが気管支壁に沿って進展するために根治切除が困難な症例も少なくない.手術では気管・気管支形成術が必要とされる症例も多い.断端陰性例に対する術後放射線療法については未だcontroversialな問題である.<br>

<i><b>Objective</b></i>. We conducted a clinicopathologic study of surgically treated cases of tracheobronchial adenoid cystic carcinoma (ACC). <i><b>Materials and Methods</b></i>. Of the 1,909 patients with lung cancer who underwent resection in our hospital and associated institutes during the 28-year period between 1980 and 2007, five (0.3%) were pathologically diagnosed as ACC of the trachea, bronchus and lung. All 5 patients were women aged from 37 to 67 years, with an average age of 50.8 years. Four tumors were located in the larger airways (one in the carina, one in the right main bronchus, one in the left main bronchus, one in the middle lobe bronchus) and one tumor was located in the peripheral lung of left S<sup>4</sup><sub>b</sub>. The following operations were done: bronchoplastic procedures in 3 (carinal resection with double-barreled carinoplasty in 1, sleeve right pneumonectomy in 1, sleeve middle lobectomy in 1), left pneumonectomy in 1, and left upper lobectomy in 1. <i><b>Results</b></i>. Three of 5 patients have survived for 172, 144, and 10 months after surgery, respectively, but 2 of the patients died 15 and 95 months after surgery, respectively (The cause of death of one patient was distant metastases to the skin, breast, and lung, and that of the other patient was colon cancer). <i><b>Conclusion</b></i>. For local treatment for ACC of the major airway, the best method is considered to be sleeve resection of the trachea or bronchus in an area where airway reconstruction may not be disturbed and to add postoperative irradiation when there is residual carcinoma at the stump. However, it seems controversial to recommend adjuvant radiotherapy in all patients undergoing resection.<br>

Journal

  • Haigan

    Haigan 48(4), 261-265, 2008-08-20

    The Japan Lung Cancer Society

References:  14

Codes

  • NII Article ID (NAID)
    110006985829
  • NII NACSIS-CAT ID (NCID)
    AN00203978
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    03869628
  • Data Source
    CJP  NII-ELS  IR  J-STAGE 
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