Search

Ciliated muconodular papillary tumor( CMPT) is a rare true pulmonary tumor consisting of bronchiolar cellular elements. Although this tumor cannot be classified as benign or malignant, it is mostly believed to be a benign bronchiolar adenoma. Recently, CMPT has been divided into two subtypes: proximal and distal. Herein, we report a case of a proximal type of CMPT containing abundant mucus cells in a 70-year-old woman. Thoracoscopic resection of the tumor in the left lower lobe was successfully performed, and the patient has been well without recurrence or metastasis for more than three years after surgery.

73歳男性．検診の際，左上肺野に異常陰影を指摘された．CTにてS1+2に直径35mm大で辺縁不整の腫瘤性病変を認め，擦過細胞診で肺腺癌疑いとの診断が得られた．術前ProGRPは，80.4pg/mlと高値を示していた．手術は，胸腔鏡下左肺上葉切除術を施行した．病理組織所見では，小さな円形の細胞が，柵状配列，ロゼット形成を示していた．また，組織のChromogranin染色は陽性を示した．上記所見より，定型的肺カルチノイド，p-T2N0M0，p1d0e0pm0，p-Stage IBとの診断となった．術後経過は良好で，ProGRP値も正常化した．定型的肺カルチノイドでは術前の血中ProGRP値が高値を示すことは少ないため，若干の文献的考察を加えて報告した．

A 59-year-old male was admitted to our hospital with an abnormal shadow on a chest X-ray. Right pneumonectomy and lymph node dissection (ND2a) were performed. A pathological examination revealed adenocarcinoma( pT3N2M0). Fourteen years later, chest computed tomography(CT) showed a tumor shadow in the lower lobe of the left lung. His pulmonary function was sufficient to allow a 2nd operation. He underwent wedge resection of the lower lobe of the left lung with the assistance of extra corporeal membrane oxygenation (ECMO). His postoperative course was uneventful. A pathological examination revealed large cell neuroendocrine carcinoma, which was 18 mm in diameter. His performance status declined slightly, but he had no problems associated with the activities of daily life. The patient is currently alive 6 months after the 2nd operation without any sign of recurrence. ECMO is a useful technique for thoracic surgery after pneumonectomy.

乳腺腺様嚢胞癌は極めて稀な疾患であり,本邦報告例もわれわれの検索した限りでは71例の報告があるのみである.今回われわれは乳腺腺様嚢胞癌の1例を経験した.症例は62歳の女性,平成13年9月9日右乳房の腫瘤を自覚して来院した.触診では右乳房のC領域に1cm大の可動性良好な硬い腫瘤を認めた.マンモグラフィーにてカテゴリーIII,エコーにて扁平・境界明瞭,内部エコー均一な腫瘤が認められ,細胞診ではclass III bであった.腫瘤を摘出した結果,乳腺腺様嚢胞癌との診断であったため乳房温存術+腋窩郭清を施行し,現在まで再発は認めていない.

症例は69歳男性.右季肋部痛を主訴に近医受診.腹部USにて胆石症を指摘され,当科紹介受診した.当科での腹部USでは,胆石と共に右側腹部に6cm大の腫瘤を認めた.腹部CTでは,右側腹部に虫垂付近へ続く嚢胞状腫瘤を認め,腹膜への浸潤を認めた.腹部MRIでは腫瘍内容物は粘液性物質が考えられた.注腸X線検査では虫垂は造影されず,上行結腸の壁外性圧排像を認めた.以上から胆石症,虫垂原発粘液嚢胞腺癌と診断し,胆嚢摘出および右半結腸切除術を施行した.病理組織学的検査では上行結腸漿膜への直接浸潤を伴う虫垂原発粘液嚢胞腺癌と診断された.虫垂癌は稀な疾患で,臨床所見は右下腹部痛が最も多い.本症例は,腫瘍が虫垂の部位から頭側へ増大したため右季肋部痛を呈し,また術前診断できた稀な症例と考えられた.

挿管後気管狭窄より気管閉塞となった症例に対し, 気管管状切除, 端々吻合を行い治癒し得たので報告する.症例は, 46歳, 女性, 自殺目的で服毒し, 人工呼吸器管理となり, 気管内挿管後8日目に抜管できた.抜管後5日目より呼吸困難出現し, 気管切開を受けて, 当院へ転院となった.頸部気管は, 声門下3cmの部分より2.8cmの長さの気管閉塞となっていた.閉塞部より1.8cm末梢にある気管切開口は麻酔に使用し, 3.2cm (6軟骨輪) の気管管状切除, 気管端々吻合を3-0マクソン糸16針にて行った.気管切開口の存在のため, 末梢側の吻合部気管は炎症性壁肥厚が残っている部分となった.切除気管は, 気管軟骨の萎縮消失と, 肉芽組織と療痕性線維で2.8cmの長さが完全閉塞していた.術後は前述の気管壁肥厚による軽度の吻合部狭窄を認めたが, 炎症の消退とともに狭窄は軽快して, 日常生活に支障は全くない.

肺の定型的カルチノイドが陳旧性結核病巣に発生した稀な症例を経験したので報告する.症例は, 75歳, 女性, 胸部X線写真で2cmのcoin lesionを指摘され, CTガイド下生検で定型的カルチノイドと診断された.胸腔鏡下右中葉切除術 (ND2a) を施行した.腫瘤は右S4aに1.1×0.9×0.5cmの大きさで, 境界明瞭, 割面は褐色であった.腫瘤の中心部は陳旧性結核病巣で, その壁に定型的カルチノイド胞巣が散在しているのが認められた.病理病期は, p-Stage I, p-T1N0M0, p0d0e0pm0で, 術後経過は良好で, 術後6ヵ月の現在再発の徴候は認められない.定型的カルチノイドといえども, リソパ節転移をきたすことがあり, 低侵襲な胸腔鏡下手術によるリソパ節郭清の良い適応と考えられる.

Primary squamous cell carcinoma of the breast is a rare disease for which no definite treatment or prognosis has been established. This report describes our experience with one case of primary squamous cell carcinoma of the breast that ended in death after rapid progression. The patient was a 58 year old woman who visited our hospital complaining of a growing tumor and pain in the right breast. Ultrasonographically the tumor consisted of solid tumor and a large cyst. Squamous cell carcinoma was diagnosed by fine-needle aspiration cytology. Neoadjuvant CEF was given, but the tumor continued to grow, so CEF was discontinued after one course and modified radical mastectomy was performed subsequently. There was no evidence of metastasis to lymph nodes. About 5 months post operatively CT of the head and chest X-ray demonstrated metastatic lesions in the brain and lungs. Resection of the cerebral tumor was performed. About 1 month after the operation, however, a new metastatic brain tumor was found and the patient later died.

We have experienced a case of delivery after mastectomy and adjuvant LH-RH agonist treatment for a breast cancer. The patient was a 29-year-old woman who underwent a pectral muscle-preserving mastectomy for multiple breast cancer in the right breast. The pathological stage was t1n0m0nomo in Stage I. Tamoxifen was ad-ministered as postoperative adjuvant endocrine therapy, which was changed to LH-RH agonist on halfway. During the course, the patient wished to havw a bady and the endocrine therapy was discontinued 2 years after the surgery. About 3 months after the final administration of LH-RH agonist, normal menstration was comfirmed and the patient became pregnant after further 7 months. She delivered a healthy boy. While pregnancy and delivery after breast cancer surgery are dealt with differently depending on the case or indivisual surgeon, we consider that positive cooperation with sufficient explanation and consent is one of the way provided that there is no problem in the postoperative course.

A questionnaire research was made for the purpose of assessing the quality of life in beast cancer patients.We prepared 27 items to be answered by patients by themselves in which each complaints were graded 4 ranks to be scored. The items included postoperative function and brachial edema, cosmetic aspects, physical and psycological parameters, familial interactions, and occupational problesm. We could collect answers from 77 patients who were operated on from January 1981 to December 1987 in our hospital. The results showed that the patients considerably suffered from cosmetic and psycological problems. The modified radical mastectomy did not alleviated these complaints. The patients felt significantly more anxiety and fear of their future and lonliness than healthy controls (n=54). The arm swelling was admitted on the patients who received radiation therapy. The younger patients had more fear of their future, but had stronger spirit in daily life than the olders.

Carcinoembryonic antigen, a serum tumor marker, is useful for diagnosing cancer and for following the response to therapy in cancer cases. Serum carcinoembryonic antigen levels are also important as a predictive tool in evaluating prognosis. A 56-year-old man presented with an abnormal shadow on a chest X-ray. His preoperative serum carcinoembryonic antigen was at an elevated level of 1274.0 ng/ml. Chest computed tomography revealed a tumor in the posterior segment of the right lung and a swollen right interlobar lymph node. Right lung pneumonectomy and node dissection were performed. A histological diagnosis determined that the tumor was a large-cell carcinoma at clinical stage IIA. Immunohistochemical analysis detected the production of carcinoembryonic antigen by the tumor cells. Following surgery, the patient's carcinoembryonic antigen levels were maintained within the normal range. This is a rare case of lung cancer with no evidence of recurrence and metastasis for 8 years despite markedly elevated preoperative carcinoembryonic antigen levels.