完全切除し得た中縦隔原発傍神経節腫の1例  [in Japanese] A Case of Middle Mediastinal Paraganglioma  [in Japanese]

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Author(s)

    • 山本 純 Yamamoto Jun
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 林原 賢治 Hayashihara Kenji
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 斎藤 武文 Saito Takefumi
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 水渡 哲史 Suito Tetsushi
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 深井 志摩夫 Fukai Shimao
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 島内 正起 Shimanouchi Masaoki
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 橋詰 寿律 Hashizume Toshinori
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 沼田 岳士 Numata Takeshi
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 塩澤 利博 Shiozawa Toshihiro
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 谷田貝 洋平 Yatagai Yohei
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital
    • 國保 成暁 Kokuho Nariaki
    • 独立行政法人国立病院機構茨城東病院呼吸器疾患部 Department of Respiratory Disease, National Hospital Organization Ibarakihigashi National Hospital

Abstract

背景.不明熱を契機に発見され,外科的切除により症状改善を認めた中縦隔原発傍神経節腫の1例を経験したので報告する.症例.64歳女性.2005年6月下旬より発熱・咳嗽が出現し,症状が軽快しないため同年7月に近医へ入院した.精査にて気管前リンパ節腫脹を指摘され,同年8月に精査加療の目的のため当院へ紹介転院となった.胸部CTでは,中縦隔に血管に富む内腔の不均一な腫瘤を認めた.FDG-PET所見では中縦隔の腫瘍にSUVmax60/120=7.3/7.9とFDGの強い集積を認め,悪性腫瘍の可能性が示唆された.気管支鏡所見では腫瘍の接している下部気管・気管分岐部の毛細血管に血管拡張を認めた.悪性腫瘍の可能性が考えられたため,胸骨正中切開・心膜切開アプローチにより腫瘍を摘出した.病理組織学的および免疫組織化学的所見より縦隔原発傍神経節腫と診断された.切除後,発熱・炎症反応は軽快し,術後約4年経過した現在,再発兆候なく健在である.結論.完全切除し得た中縦隔原発傍神経節腫の1例を経験した.重要臓器が密集する中縦隔の腫瘍摘出術においては胸骨正中経路からのアプローチが非常に有効であった.

Background. We report a case of middle mediastinal paraganglioma with fever of unknown origin, treated by resection. Case. A 64-year-old woman had a fever and cough in June 2005, and was admitted to a previous hospital for examination in July 2005. Pretracheal lymph node swelling was pointed out, so she was referred to our hospital for further examinations in August 2005. Her contrast medium-enhanced chest CT revealed a heterogeneously enhanced tumor with hypervascularity in the middle mediastinum. FDG-PET revealed a maximum standardized uptake value (SUVmax)60/120 values of the middle mediastinal tumor as 7.3/7.9 and we suspected a malignant tumor. Bronchoscopic findings on admission showed hypervascularity in the capillaries in the lower trachea and carina close to the tumor. Complete resection of the middle mediastinal tumor was performed by median sternotomy and opening the pericardium. Histologic examination and immunohistochemical staining of the tumor revealed paraganglioma of the middle mediastinum. She remains alive and well with no sign of recurrence or metastasis 4 years after the operation. Conclusion. We reported a case of a middle mediastinal paraganglioma. A median sternotomy can be very effective for complete resection of a middle mediastinal tumor.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 32(3), 285-290, 2010

    The Japan Society for Respiratory Endoscopy

References:  7

Codes

  • NII Article ID (NAID)
    110007619659
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0287-2137
  • Data Source
    CJP  NII-ELS  J-STAGE 
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