呼吸器内視鏡検査が胸膜・肺転移の診断に有用であった術後15年目の再発乳癌の1例  [in Japanese] Recurrent Breast Cancer 15 Years After Radical Mastectomy in Which Respiratory Endoscopy Was Effective in the Diagnosis of Pleural and Pulmonary Metastasis  [in Japanese]

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Author(s)

    • 山田 秀哉 Yamada Shusai
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 三上 浩司 Mikami Koji
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 野木 佳孝 Nogi Yoshitaka
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 平山 倫子 Hirayama Noriko
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 寺田 貴普 Terada Takayuki
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 岡田 あすか Okada Asuka
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 村上 亜紀 Murakami Aki
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 田村 邦宣 Tamura Kunihiro
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 栗林 康造 Kuribayashi Kozo
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 中野 孝司 Nakano Takashi
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 福岡 和也 Fukuoka Kazuya
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 田端 千春 Tabata Chiharu
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 安光 亮洋 Yasumitsu Akihiro
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 政近 江利子 Masachika Eriko
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 前田 理沙 Maeda Risa
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 大桑 久弥 Okuwa Hisaya
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 神谷 瞳 Kamiya Hitomi
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine
    • 本田 実紀 Honda Miki
    • 兵庫医科大学内科学呼吸器RCU科 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine

Abstract

背景.胸水貯留例に対し局所麻酔下胸腔鏡検査が有用である.症例.75歳女性.1995年1月,近医にて右乳癌に対し乳房切除術を施行.術後タモキシフェン,フルオロウラシルを2年間投与され,経過観察されていた.2009年10月,健診時の胸部X線にて,右胸水を認め当科に紹介となった.胸水検査では原因となる所見は得られなかった.^<18>F-fluorodeoxyglucose positron-emission tomography (^<18>FDG-PET)にて右下葉と頸椎,胸椎などに多発するFDGの集積充進を認め,血清CA15-3 30.9U/mlと高値であり,乳癌の肺転移,骨転移が疑われた.気管支内視鏡にて乳癌肺転移と診断局所麻酔下胸腔鏡では,壁側胸膜に多発結節を認め,生検にて乳癌の胸膜転移と診断した.結論.呼吸器内視鏡検査は病理組織学的検索により,乳癌の胸膜転移や肺転移の診断や肺癌との鑑別に有用であると考えられた.

Background. Thoracoscopy under local anesthesia is useful in patients with retention of pleural fluid. Case. A 75-year-old woman had undergone a standard radical mastectomy followed by adjuvant chemotherapy for right breast cancer at the age of 60 in January 1995. Her subsequent progress was monitored by endocrine therapy with tamoxifen and fluorouracil for 2 years. She was referred to our hospital 15 years later for medical evaluation and treatment after right pleural effusion was detected on chest X-ray films taken during a regular medical checkup in October 2009. ^<18>F-fluorodeoxyglucose positron-emission tomography (^<18>FDG-PET) showed abnormal accumulation in the lower lobe of the patient's right lung, cervical vertebrae and thoracic vertebrae. Her serum CA15-3 level was elevated (30.9U/ml) and breast cancer with pulmonary metastasis and multiple bone metastasis were suspected. Examination of her pleural effusion obtained by thoracocentesis did not yield a definitive diagnosis, so thoracoscopy under local anesthesia and bronchoscopy were performed. Recurrent breast cancer with carcinomatous pleuritis, pulmonary metastasis, and multiple bone metastasis were diagnosed. Conclusion. Respiratory endoscopy was very useful in the diagnosis of recurrent breast cancer with carcinomatous pleuritis, pulmonary metastasis and also for the differentiation of the lung cancer lesion.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 33(4), 250-255, 2011

    The Japan Society for Respiratory Endoscopy

References:  11

Cited by:  1

Codes

  • NII Article ID (NAID)
    110008687251
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0287-2137
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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