特発性間質性肺炎合併肺癌における術後急性増悪の臨床病理学的検討 [in Japanese] Clinicopathologic Considerations of Postoperative Acute Exacerbation in Patients With Idiopathic Interstitial Pneumonia Combined With Lung Cancer. [in Japanese]
Access this Article
<B>目的・方法</B>. 特発性間質性肺炎 (idiopathic interstitial pneumonia: IIP) 合併肺癌症例における術後IIP急性増悪についての臨床病理組織学的検討を行った. <B>結果</B>. 原発性肺癌手術症例224例中, 病理組織学的検索にてusual interstitial pneumonia (UIP) パターンを呈した症例は9例 (4%) であった. その内, 術後急性増悪を起こした症例は2例 (22%) で, 各々7, 9病日に増悪した. 増悪群, 非増悪群での術前因子 (CRP, LDH, WBC, PaO<SUB>2</SUB>,%VC), 術中因子 (出血量, 手術時間, 術後CPK最大値) に増悪の危険性を予測できる傾向は見出せなかった. 但し切除標本では9例中4例で線維芽細胞巣が著明であり, 内, 2例 (50%) に増悪が認められた. <B>結論</B>. 病理組織学的に顕著な線維芽細胞巣の出現が術後急性増悪の危険因子になる可能性が推測された.
<I><B>Objective</B></I>. In 9 patients operated on for idiopathic interstitial pneumonia (IIP) associated with primary lung cancer, we clinicopathologically examined the predictive factors of postoperative acute exacerbation of IIP. <I><B>Methods</B></I>. We collected 9 patients who had been operated on for lung cancer and in whom a pathological diagnosis of usual interstitial pneumonia (UIP) pattern had been made based on resected tissues. We studied some predictive factors related to the acute exacerbation of IIP preoperatively and during operation, and analyzed the pathological findings of UIP. <I><B>Results</B></I>. The incidence of postoperative acute exacerbation of IIP was 22%(2 of 9 patients). No correlation between the two patients who developed acute exacerbation of IIP and the seven patients who did not was observed, in terms of CRP, LDH, WBC, PaO<SUB>2</SUB> and %VC of preoperation, blood loss, operation time and postoperative maximum CPK. Pathologically, abundant fibroblastic foci were observed in 4 patients and a half of them developed acute exacerbation of IIP at 7 and 9 days postoperatively. <I><B>Conclusion</B></I>. It was difficult to predict the development of acute exacerbation of HP because most patients were in a controlled stable state of IIP preoperatively. However, we considered that abundant fibroblastic foci in the tissue specimens known as pathologically active lesions of UIP were possibly one of the predictive factors in the acute exacerbation of IIP.
Haigan 42(6), 567-572, 2002
The Japan Lung Cancer Society