症例 89歳に手術を行った原発性肺多形癌の一例

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原発性肺多形癌は,低分化な非小細胞癌で,紡錘細胞あるいは巨細胞を10%以上含むか紡錘細胞と巨細胞のみからなる腫瘍である.発症平均年齢はおよそ65歳で,男女比4.5:1と男性に多い.頻度は全肺腫瘍の約0.3%で,肺右上葉に好発し,喫煙との関連が大きい.リンパ節転移は比較的少ないが,発育が非常に早く,早期に胸膜浸潤や遠隔転移を起こす.また,ほとんどが切除検体の病理検査で確定診断されることが多く,術前に診断をつけるのは困難である.一方,化学療法の効果は低く,現時点では手術以外に根治が望める治療法はない.予後は非常に不良で,Fishbackらの報告によると,5年生存率は10%程度である.今回,89歳と高齢ではあったが,このように悪性度の高い原発性肺多形癌に対して根治切除を行った1例を経験したので報告する.A-89-year-old male patient who complained dry cough was detected lung mass of 3 cm size in diameter at the right upper lobe by CT. FDG-PET seemed to show hilar and mediastinum lymph nodes metastasis. After three weeks, the mass showed rapid growth with 5 cm diameter in size at CT. Therefore the original tumor was supposed to be undifferentiated carcinoma, above all, pleomorphic carcinoma. He had been done pulmonary resection after short period. The right upper lobectomy with combined resection of the partial middle lobe was performed. Hilar and mediastinum lymph nodes dissection was added. In pathological examination, the tumor was proved pleomorphic carcinoma, however, no lymph node metastasis was recognized. He did not refer any complications and discharged back home at the post-operative 11th day. Pleomorphic carcinoma of the lung is known to be difficult to obtain definite diagnosis in early stage because of rapid growth. Therefore many cases are detected in advanced stage. In addition, chemotherapy is generally not effective, so only operative resection seems to be useful. Our patient was 89-year-old, he tolerated the operation and was alive with no trouble during 6 months after resection. When complete resection seems to be possible, operation should be regarded as an initial treatment.
2012-09-25

症例 89歳に手術を行った原発性肺多形癌の一例

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