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| 1.
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西田, 沙貴 ; 小田, 誠 ; 松本, 勲 ; 田村, 昌也 ; 早稲田, 龍一 ; 渡邊, 剛 ; Nishida, Saki ; Oda, Makoto ; Matsumoto, Isao ; Tamura, Masaya ; Waseda, Ryuichi ; Watanabe, Go
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金沢大学医薬保健研究域医学系<br />症例は59歳，女性．3年前に子宮体癌を疑われ準広汎子宮全摘術，S状結腸切除術を施行された．病理診断および精査の結果，原発性肺腺癌の腹腔内転移と診断された．その後の経過で，計6レジメンの化学療法と計10
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0Gyの放射線治療が施行された．転移巣の制御は良好であったが，原発巣の増大傾向を認めたため，手術目的に当科紹介となった．手術は，肺門部において，肺動脈および上葉気管支と周囲組織との強固な癒着を認めたため，これらを一括して鉗子にてクランプした後に切離し，断端を3-0vicryl糸にて縫合して閉鎖した．断端は有茎傍心膜脂肪織にて被覆した．術後の病理診断で，低分化肺腺癌と診断された．術後さらに補助化学療法を追加し，術後9ヵ月間再発転移は認めていない．高容量化学放射線療法による炎症にて肺門部の処理が困難な症例に対しては，肺門部一括処理および有茎傍心膜脂肪織による気管支・肺動脈切離断端の被覆が有用であると考える．<br />A 59-year-old female was referred to our hospital for stage IV (cT3N2M1b) adenocarcinoma of the right lung. At the age of 56, at another hospital, she had undergone extended hysterectomy and resection of the sigmoid colon for suspected endometrial carcinoma and had received a diagnosis of lung adenocarcinoma based on pathological findings, a CT scan, and other examinations. A total of six regimens of chemotherapy and radiotherapy with a total dose of 100 Gy had been performed over 3 years, but it was resistant. Therefore, she was referred to our hospital to consider surgical treatment. We performed a right upper lobectomy because the tumor was localized and no other metastatic lesion was found. We ablated the tumor from the chest wall because it grew to the apical chest wall. In the hilum of the lung, individual ligation and closure of the pulmonary vessels and bronchus was found to be impossible because they tightly adhered to the peripheral tissue. Therefore, the hilar vessels and bronchus were clamped and cut in one mass. Their stumps were oversewn with 3-0 vicryl and covered with a pedicled pericardial flap. The post operative course was favorable, and the patient underwent adjuvant chemotherapy at the hospital that had originally referred her to us. She was free of clinically evident recurrence 9 months after treatment. We suggest that the mass closure of the hilar vessels and bronchus and covering the stumps with a pedicled pericardial flap are useful for cases in which it is difficult to individually close the vessels and bronchus due to ligneous scarring caused by radiation.
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大竹, 由美子 ; 小田, 誠 ; 清水, 淳三 ; 太田, 安彦 ; 林, 義信 ; 川上, 卓久 ; 渡辺, 洋宇 ; 野々村, 昭孝 ; Ohtake, Yumiko ; Oda, Makoto ; Shimizu, Junzo ; Ohta, Yasuhiko ; Hayashi, Yoshinobu ; Kawakami, T. ; Watanabe, Yoh ; Nonomura, Akitaka
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金沢大学医薬保健研究域医学系<br />A 63-year-old male had squamous cell carcinoma in the left upper lobe. CT scan suggested the invasio
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n of the tumor into the vertebral body and the descending aorta. Left pneumonectomy and combined aortic resection under the temporary bypass using Anthron tube was performed. The bypass using Anthron tube provides us no systemic heparinization and the procedure is easy. So the danger of massive bleeding during and after the operation can be decreased and the operative time can also be shortened. This procedure may be a great help for carrying out the operation with combined aortic resection more safely and speedily.
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荒能, 義彦 ; 清水, 淳三 ; 村上, 眞也 ; 林, 義信 ; 小林, 孝一郎 ; 関戸, 伸明 ; 森田, 克哉 ; 持木, 大 ; 富田, 重之 ; 渡辺, 洋宇 ; Arano, Yoshihiko ; Shimizu, Junzo ; Murakami, Shinya ; Hayashi, Yoshinobu ; Kobayashi, Ko-ichi ; Sekido, Nobuaki ; Morita, Katsuya ; Mochiki, Y. ; Tomita, Shigeyuki ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />A 72-year-old female was admitted with complaints of cough and sputum. The chest X-ray film revealed
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a solitary round mass and pleural effusion in the left lower lung field. Laboratory tests demonstrated elevated levels of serum HCG and beta-HCG. Left lower lobectomy with parietal pleurectomy was performed under the diagnosis of primary lung cancer with malignant effusion. The serum HCG level decreased after the operation. Histologically, the tumor was diagnosed as moderately differentiated papillo-tubular adenocarcinoma of the lung. In the HCG staining using an immunohistochemical method, the tumor cells showed a positive reaction. Thus, this tumor was definitively diagnosed to be HCG-producing adenocarcinoma of the lung.
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小田, 誠 ; 金森, 太郎 ; 丸川, 洋平 ; 伊藤, 祥隆 ; 石川, 暢己 ; 田村, 昌也 ; 呉, 哲彦 ; 渡辺, 俊一 ; 太田, 安彦 ; 渡辺, 剛 ; 渡辺, 洋宇 ; Oda, Makoto ; Kanamori, Taro ; Marukawa, Yohei ; Itoh, Y. ; Ishikawa, Y. ; Tamura, Masaya ; Go, Tetsuhiko ; Watanabe, Shun-ichi ; Ohta, Yasuhiko ; Watababe, Go ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />The purpose of this study was to evaluate the results of new TNM staging system for lung cancer in 1
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997, especially T3N0M0, stage IIIA, stage IIIB, and pm. Five-year survival rates of the patients with stage IIIA and stage IIIB were 16% and 18% respectively (NS). Five-year survival rates of patients with T3N1M0, T1N2M0, T2N2M0, and T3N2M0 were 40%, 28%, 15%, and 3%, respectively. The prognosis of T3N2M0 was significantly worse than that of T3N1M0, T1N2M0, and T2N2M0. Five-year survival rates of the patients excluding pm 1 with T4N0M0, T4N1M0, T4N2M0, and T4N3M0 were 21%, 10%, 10%, and 0%, respectively. The prognosis of the patients with T4N0 was significantly better than that of T4N2 and T4N3. In the patients with pm, 5-year survival rates of the patients with pm 1 and pm 2 were 26% and 7%, respectively (p < 0.01). In the patients with pm 1, 5-year survival rates of the patients with N0 + N1 and N1 + N2 were 53% and 16%, respectively (p < 0.01). From our these results, we supported the new TNM system as putting T3N0M0 to stage IIB, putting pm 2 into stage IV. We proposed; 1) chest wall invasion with bone destruction stay in stage IIIA or is T4, 2) T3N1M0 is classified with stage IIB, 3) main stem bronchus invasion is classified with T2, 4) pm 1 is subdivide by N status. Furthermore, stage III seemed to be reasonably subdivided into T1-2N3M0, T4N0-1M0 as stage IIIA and T3-4N2, T1-4N3 as stage IIIB.
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小田, 誠 ; 金森, 太郎 ; 伊藤, 祥隆 ; 石川, 暢己 ; 田村, 昌也 ; 呉, 哲彦 ; 渡辺, 俊一 ; 太田, 安彦 ; 渡辺, 剛 ; 渡辺, 洋宇 ; Oda, Makoto ; Kanamori, Taro ; Itoh, Y. ; Ishikawa, Y. ; Tamura, Masaya ; Go, Tetsuhiko ; Watanabe, Shun-ichi ; Ohta, Yasuhiko ; Watababe, Go ; Watanabe, Yoh
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金沢大学医薬保健研究域医学系<br />The purpose of this study was to evaluate the results of carinal resection for bronchogenic carcinom
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a in our institute. From 1981 to 1999, 24 carinal resection were performed for squamous cell carcinoma (n = 19), adenoid cystic carcinoma (n = 2), small cell carcinoma (n = 1), adenocarcinoma (n = 1), and mucoepidermoid carcinoma (n = 1). Nineteen underwent sleeve pneumonectomy, 2 had carinal resection without lung resection, 2 had carinal resection with right middle and lower lobectomy, and 1 had wedge pneumonectomy. In the patients with sleeve or wedge pneumonectomy, there were 5 operative death and 3 patients had survived for more than 3 years. Two patients with low-grade malignant tumors underwent carinal resection without lung resection and survived more than 10 years. We believe that limited carinal resection for low-grade malignant tumors are safe and valuable procedure. Careful selection of patients with sleeve or wedge pneumonectomy is mandatory.
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常塚, 宣男 ; 石川, 紀彦 ; 平沼, 知加志 ; 佐藤, 日出夫 ; 小田, 誠 ; 渡辺, 剛 ; Tsunezuka, Yoshio ; Ishikawa, Norihiko ; Hiranuma, Chikashi ; Sato, Hideo ; Oda, Makoto ; Watanabe, Go
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金沢大学医薬保健研究域医学系<br />From January 1997 to June 1999, we performed surgery in 17 patients with mycobacteria other than tub
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erculosis (MOTT), and 2 patients with lung cancer among them. Both patients had the diagnosis of MOTT by sputa bacterial cultures preoperatively, but no diagnosis of lung cancer. By computed tomography (CT) scanning, lung cancer was suspected in both patients, therefore they were performed video-assisted thoracoscopic resection of the lung. The diagnosis of malignancy was made by intraoperative frozen section of resected tissue, the patients were performed lobectomy with systematic mediiastinal lymph nodes dissection. According to increment of detection of the small peripheral lesion, infectious disease such as MOTT can be detected as small abnormal shadow by CT. However, it is difficult to distinguish malignancy from infectious disease preoperatively. Even if a preoperative diagnosis, of MOTT was made like present cases, diagnostic video-assisted thoracoscopic surgery must be performed, considering that lung cancer could combined with MOTT.
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太田, 安彦 ; 清水, 洋介 ; 加藤, 陽介 ; 松本, 勲 ; 田村, 昌也 ; 小田, 誠 ; 湊, 宏 ; 渡辺, 剛 ; Ohta, Yasuhiko ; Shimizu, Yosuke ; Kato, Yosuke ; Matsumoto, Isao ; Tamura, Masaya ; Oda, Makoto ; Minato, Hiroshi ; Watanabe, Go
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金沢大学医薬保健研究域医学系<br />This retrospective analysis was undertaken to review our results of treatment of lung cancers with i
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nvasion of non-apical and non-vertebral chest wall structures. In summary of our experience, although relatively good prognosis can be expected in N0M0 patients with the histological type of adenocarcinoma by initial operation, distant relapse remains a major problem of the disease. Furthermore, our results are in agreement with the idea that postoperative adjuvant therapy is of little value in patients with complete resection. To ameliorate surgical outcomes, induction treatment should be considered and preoperative staging assessment needs to be strictly done for proper selection of patients with this locally advanced disease. The indication of initial operation needs to be cautiously determined for patients with this disease.
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呉, 哲彦 ; 小田, 誠 ; 渡邊, 剛 ; 村上, 眞也 ; 野々村, 昭孝 ; 湊, 宏
概要:
金沢大学医薬保健研究域医学系<br />Background. We encountered a case of adenocarcinoma of hilar type lung cancer detected by sputum cyt
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ology, with a unique tumor growth pattern. Case. A 58-year-old man complaining of a persistent cough had no tumor shadow on chest roentgenogram. However, sputum cytology revealed Class V malignant cells. Bronchoscopic findings showed faded white yellowish mucosa at the spur of the right B^1, B^2, B^3 segmental bronchi. A computed tomograph showed only thickenings of the bronchial walls from the right upper lobe bronchus to the main bronchus. Bronchial biopsy of the dull spur revealed adenocarcinoma. Right sleeve upper lobectomy and lymph node dissection were performed, and the right main bronchus was excised just below the carina due to spread of cancer. The lesion was pathologically diagnosed as a well-differentiated papillary adenocarcinoma, located at the hilar portion of the lung, which had spread mainly in the mucosa from just below the carina and within 2 rings from the bifurcation of middle and lower bronchus and to the subsegmental bronchi of B^1, B^2, B^3 peripherally. Postoperative irradiation was administered and the patient has been free from cancer for 6 years after surgery. Conclusion. We report a rare case of mucosal spreading hilar adenocarcinoma of the lung. More cases need to be analyzed to elucidate the pathophsyology of this type of lung cancer. 背景.喀痰細胞診での肺門部肺癌の発見例はほとんどは扁平上皮癌であり腺癌はまれである.我々の経験した粘膜内を表層伸展する肺門部肺腺癌の1例を報告する.症例.58歳の男性.咳漱を主訴に近医を受診し喀痰細胞診でClass Vと判定された.気管支鏡にて右上葉支B^1,B^2,B^3分岐部に黄白色の粘膜褪色部位が見られ,同部位よりの生検で肺腺癌の診断を得た.胸部CTでは右上葉支から右主気管支にかけて気管支壁の肥厚が見られた.術前診断T1N0M0の肺門部早期肺腺癌の診断にて右肺管状上葉切除およびND2bのリンパ節郭清を施行した.術中病理診断にて右主気管支中枢側断端に癌の浸潤を認めたため,気管分岐部直下まで追加切除し中間気管支幹と端々吻合を行った.病理組織学上,末梢側はB^1,B^2,B^3の亜亜区域支まで,中枢側は気管分岐部直前および中下葉支人口部2軟骨輪前までの範囲にわたり,粘膜に沿った伸展が高度な肺門部肺臓癌と診断された.術後病期はT3N0M0,IIB期であった.吻合部への放射線治療を追加し術後6年で再発の兆候は認めていない.結論.粘膜内を表層伸展する極めてまれな肺門部腺癌の1例について報告した.
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石黒, 卓 ; 笠原, 寿郎 ; 木村, 英晴 ; 安井, 正英 ; 藤村, 政樹
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金沢大学医薬保健研究域医学系<br />Background. Brain metastasis is often seen in patients with lung cancer; however, the reported incid
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ence of pituitary metastasis is rare. We present a case with central hypopituitarism secondary to pituitary metastasis from lung cancer. Case. A 78-year-old woman had been receiving treatment on an outpatient basis at a local hospital for the control of diabetes mellitus since 1998. A chest roentgenogram revealed a huge mass in the middle lung field of the left lung in February, 2006 and she was referred to us. A bronchoscopic biopsy in March revealed adenocarcinoma. Systemic examinations showed multiple lung metastases and bone metastases, and brain MRI also showed focal metastasis to the right occipital lobe, thus indicating a clinical stage of T4N3M1 (stage IV). She was admitted to our department due to severe appetite loss for 1 week. She complained of polyuria, thirst, and polydipsia. We performed a hematological examination including basal endocrinological conditions, a high concentration saline loading test, the response to desmopressin administration, and the findings of brain MRI, which led to a diagnosis of metastasis of lung cancer to the pituitary gland with central diabetes insipidus. Although chemotherapy did not improve the symptoms of diabetes insipidus, the intranasal administration of desmopressin improved them. Her appetite loss promptly improved after the administration of desmopressin. Conclusion. We should suspect the possibility of a metastatic pituitary tumor in a patient has diabetes insipidus. If such tumors can be accurately identified, appropriate treatment can result in an improvement in the quality of life for patients with advanced lung cancer. © 2007 The Japan Lung Cancer Society. 背景．肺癌の脳転移は高い頻度で認められるが，下垂体に転移することはまれである．今回われわれは下垂体転移により中枢性尿崩症を呈した症例を経験したので報告する．症例．症例は78歳女性．1998年より糖尿病の加療のために近医へ通院していた．2006年2月，胸部X線写真で左上肺野に腫瘤影を指摘され，当科に紹介となった．3月に気管支鏡検査を施行し，経気管支鏡的生検によって肺腺癌と診断した．全身精査の結果，多発肺内転移，骨転移，および頭部MRI検査にて右後頭葉への転移を認め，病期はT4N3M1（IV期）であった．入院1週間前から食欲不振が強くなったため，4月に精査加療目的で入院した．患者は多尿，口渇，多飲を認め，血液検査や高張食塩水負荷試験，酢酸デスモプレシン投与後の反応および頭部MRI所見により，転移性の下垂体腫瘍および中枢性尿崩症と診断した．化学療法は尿崩症症状に対して改善を示さなかったが，酢酸デスモプレシン投与によって食欲不振および患者のQOLは著明に改善した．結論．尿崩症患者をみた場合には，転移性下垂体腫瘍を鑑別にあげることが重要で，これに対する適切な治療により進行癌患者のQOLを改善できることが示唆された.
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野畑, 浩一 ; 辻, 博 ; 笠井, 孝彦 ; 藤村, 政樹 ; 石浦, 嘉久 ; 中尾, 眞二
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金沢大学附属病院内分泌・総合外科<br />Background. Although there are some reports of lung cancer complicated by membranous nephropathy,
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the mechanism of their simultaneous occurrence is not well understood. Case. A 69-year-old man was admitted to our hospital complaining of right back pain. Chest X-ray examination revealed a massive shadow in the right upper lobe. The tumor mass was diagnosed as poorly differentiated squamous cell carcinoma of the lung (T2N3MO Stage IIIB). Urinary protein excretion was 2.6 g/day. The serum level of cytokeratin 19 fragment (CYFRA21-1) was 39.1 ng/ml. Combination chemotherapy with carboplatin and docetaxel hydrate was started. A partial response was finally obtained after five courses. Serum level of CYFRA21-1 and amount of urinary protein excretion were decreased to 7.1 ng/ml and 0.1 g/day. After discharge, the lung cancer progressed and he finally died of respiratory failure. Adenosquamous carcinoma of the lung and membranous nephropathy were proven by autopsy. Conclusion. This case appears to have exhibited parallel time courses of progression of adenosquamous carcinoma of the lung, membranous nephropathy and changes in serum CYFRA21-1 level. This is of interest in considering the mechanism of the complication of lung cancer by membranous nephropathy. (JJLC. 2003;43:137-14l) 背景.肺癌に膜性腎症を合併する症例はしばしば経験されるが、その因果関係については明確にされていない。症例.69歳、男性.右背部痛を上訴として来院した。胸部X線写真にて右上葉に異常陰影を指摘され、気管支鏡下生検にて低分化肺扁平上皮癌(T2N3MO Stage IIIB)と診断された。また蛋白尿もみられ、入院時の1日尿蛋白量は2.6g であった。Cvtokeratin 19 fragment (CYFRA21-1)は39.1 ng/ml と高値であった。Carboplatinとdocetaxel hydrateによる化学療法を5クール施行し、膜瘍は縮小し、CYFRA21-1も低下(7.1 ng/ml)するとともに、尿蛋白量も減少した(0.1g/day)。退院後、肺癌は再び増大し、最終的には呼吸不全に陥り死亡した。剖線によって、原発巣の線線型は腺扁平上皮癌,腎病変は膜性腎症であることが示された。結論.自膜例は尿蛋白の線過がCYFRA21-1の変化と一致した膜性腎症合併肺腺扁平上皮癌症例であり、肺癌と膜性腎症との関係を考察する上で興味深い症例と考えられた。(肺癌.2003:43:137-141)
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