Hepatoid adenocarinomaと考えられたα-fetoprotein産生肺癌の1例 [in Japanese] A Case Report of Hepatoid Adenocarcinoma of the Lung [in Japanese]
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<b>背景．</b>Hepatoid adenocarcinoma of the lungはα-fetoprotein産生肺癌の一種であり，肝細胞癌様の組織形態を呈する稀な疾患である．<b>症例．</b>75歳，男性．健康診断の胸部CTで左肺下葉に腫瘤影を指摘された．呼吸器内科で精査され原発性肺癌の診断に至り，当科で手術（胸腔鏡補助下左肺下葉切除＋縦隔郭清術）を施行された．病理組織学的所見は，AFP陽性で肝細胞癌に類似した組織形態を呈しており，hepatoid adenocarcinoma of the lungの診断に至った．術後経過は良好であった．術直後の血清α-fetoproteinは異常高値であったが，術後2か月以降基準値内で経過している．退院後外来で経過観察されているが，現時点では無再発生存中である．<b>結論．</b>本疾患は予後不良とされており，術後は血清α-fetoprotein値と各種画像検査による厳重な経過観察が必要と考える．
<b><i>Background. </i></b>Hepatoid adenocarcinoma of the lung is a α-fetoprotein-producing lung cancer and a rare disease with a hepatocellular carcinoma-like tissue form. <b><i>Case. </i></b>We herein report the case of a 75-year-old man with a α-fetoprotein-producing cancer diagnosed as hepatoid adenocarcinoma of the lung. The patient was referred to our hospital for an investigation of an abnormal shadow in the left lung found on CT of the chest at a group medical examination. He was subsequently diagnosed with primary lung cancer based on an investigation in the respiratory internal medicine department, at which time left lower lobectomy with mediastinal lymph node dissection was performed under thoracoscopic assistance. The histopathological morphology of the resected tumor tissue was similar to that of hepatocellular carcinoma, and the tumor was immunohistochemically positive for α-fetoprotein. Therefore, we diagnosed the α-fetoprotein-producing lung cancer as hepatoid adenocarcinoma of the lung. The patient's postoperative course was uneventful. Although the serum α-fetoprotein level immediately after the operation was abnormally high, it returned to the normal range approximately two months after the surgery. The patient is currently doing well without any signs of recurrence. <b><i>Conclusions. </i></b>As the prognosis of hepatoid adenocarcinoma of the lung is poor, long-term follow-up while carefully monitoring the serum α-fetoprotein levels and utilizing various imaging modalities is essential after surgery.
Haigan 55(3), 161-165, 2015
The Japan Lung Cancer Society