Wilms腫瘍の胸膜播種に続発した多発ブラによる両側気胸の1例 [in Japanese] A Case of Recurrent Pneumothorax Secondary to Pleural Dissemination of Wilms Tumor [in Japanese]
Access this Article
Search this Article
症例は11歳女児.Wilms腫瘍(favorable histology,stage IV)に対し,4歳時に左腎摘術・下大静脈から右房内の腫瘍栓摘出術が施行された.術前後に化学療法,放射線療法,陽子線治療が行われた.5歳時に左気胸,9歳時に右気胸の既往があり,CTで両肺に複数のブラが指摘されていた.11歳4か月時,右気胸を生じドレナージで改善したが,3か月後に再発し手術を施行した.右肺の表面には多数のブラが認められ,上葉切除術および中・下葉のブラ切除術を行った.右肺術後6か月時と11か月時に左気胸を発症し,ブラ切除術を行った.病理組織診断で,ブラの壁や臓側胸膜に横紋筋様の間葉系成分と,尿細管様の上皮系成分が認められ,Wilms腫瘍の胸膜播種によりブラが形成され,気胸が生じたと考えられた.転移性肺腫瘍による続発性気胸は比較的稀である.今回,Wilms腫瘍に続発した気胸を経験したので文献的考察を加え報告する.
An 11-year-old girl was referred to our department because of right pneumothorax. She previously underwent left nephrectomy and tumor embolectomy of the IVC for stage IV Wilms tumor at 4 years of age. Perioperative chemotherapy, postoperative radiation therapy and proton therapy were added. Multiple bullae were detected by the chest computed tomography and she had two episodes of pneumothorax, the left at 5, and the right at 9 years of age. Both episodes were treated by drainage alone. Right pneumothorax recurred when she was 11 years old, which necessitated surgical treatment. Intraoperatively, the right lung was covered by multiple bullae, therefore upper lobectomy and bullectomy were performed. Six and eleven months later, left pneumothorax occurred, which was treated by bullectomy. Histopathologically, the wall of the bullae included tumor cells of Wilms tumor. Therefore, we speculated that pleural dissemination is related to the development of bullae. She has been free from pneumothorax for 12 months postoperatively. We herein report a rare case of bilateral pneumothorax secondary to bullae formed by pleural dissemination.
- Journal of the Japanese Society of Pediatric Surgeons
Journal of the Japanese Society of Pediatric Surgeons 47(6), 963-968, 2011
The Japanese Society of Pediatric Surgeons