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| 1.
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常塚, 宣男 ; 清水, 淳三 ; 小田, 誠 ; 関戸, 伸明 ; 和田, 真也 ; 渡辺, 洋宇 ; Tsunezuka, Yoshio ; Shimizu, Junzo ; Oda, Makoto ; Sekido, Nobuaki ; Wada, Masanari ; Watanabe, Yoh
概要:
金沢大学医薬保健研究域医学系<br />症例は55歳, 女性.主訴は咳嗽.胸部X線写真にて, 右上肺野に腫瘤陰影を指摘された.術前に確定診断は得られなかったが肺癌を疑って, 右上葉切除術を施行した.切除標本の病理組織検査では形質細胞の腫瘍性
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増殖を認めたが, 一部にリンパ濾胞の形成, リンパ球の巣状配列を認め, 形質細胞腫とCastlemanリンパ腫-Plasma cell typeとの鑑別が問題となった.PAP法による免疫組織化学的検査の結果, IgA-λ型の単クローン性の染色性を持つ肺原発性の形質細胞腫と診断された.組織学的にCastlemanリンパ腫と類似した形質細胞腫は, われわれが調べ得た範囲では本邦3例目であるが, 肺原発の症例は過去に報告例がない.<br />Extramedullary plasmacytomas are uncommon tumors that affect various tissues, most commonly in the upper airways. We report a case of solitary plasmacytoma of the lung that was difficult to differentiate histopathologically from Castleman's lymphoma.A 55-year old woman was admitted to our hospital with an abnormal shadow on chest X-ray films but no symptoms. Chest CT scan disclosed a solitary nodule with low density in the right upper lobe. Right upper lobectomy was performed, and histological examination showed diffuse proliferation of plasma cells and lymphoid follicles partially similar to Castleman's lymphoma. Immunohistologically, the plasmacytoma cells were stained with IgA and λ chains in a monoclonal secretory pattern.
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| 2.
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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
概要:
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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| 3.
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滝沢, 昌也 ; 小田, 誠 ; 太田, 安彦 ; 川上, 和之 ; 常塚, 宣男 ; 松本, 勲 ; 田村, 昌也 ; 谷内, 毅 ; 渡辺, 剛 ; 高仲, 強 ; 西嶋, 博司 ; 松井, 修 ; Takizawa, Masaya ; Oda, Makoto ; Ohta, Yasuhiko ; Kawakami, Kazuyuki ; Tsunezuka, Yoshio ; Matsumoto, Isao ; Tamura, Masaya ; Yachi, Tsuyoshi ; Watanabe, Go ; Takanaka, Tsuyoshi ; Nishijima, Hiroshi ; Matsui, Osamu
概要:
金沢大学医薬保健研究域医学系<br />We evaluated the efficacy of perioperative targeting brachytherapy for lung cancer invading the ches
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t wall. Between 1998 and 2003, 7 patients underwent perioperative targeting brachytherapy for lung cancer invading the chest wall. There were 5 male and 2 female patients. The mean age was 63.3 years, with a range of 45 to 77 years. All patients underwent complete resection including the chest wall combined resection. During the operation, plastic afterloading catheters fixed on the Vicryl mesh at interval of 1 cm were placed on the site of chest wall resection. From the third to sixth day after the operation, 15 to 32 Gy of radiation was delivered over 3 or 4 days using a high dose rate remote afterloading system. The area targeted for brachytherapy was determined by a computed tomography (CT) scanner translator with a computer program for radiation planning. The median postoperative hospital stay was 35 days. Local recurrences were observed in 2 patients, but there was no evidence of recurrence in the margin of the resected chest wall. We believe that this short period of treatment and the low side effects enhances the quality of the patients. Prevention of local recurrence was achieved in short term follow-up.
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田村, 昌也 ; 小田, 誠 ; 滝沢, 昌也 ; 谷内, 毅 ; 松本, 勲 ; 常塚, 宣男 ; 川上, 和之 ; 渡辺, 剛 ; Tamura, Masaya ; Oda, Makoto ; Takizawa, Masaya ; Yachi, Tsuyoshi ; Matsumoto, Isao ; Tsunezuka, Yoshio ; Kawakami, Kazuyuki ; Watanabe, Go
概要:
金沢大学医薬保健研究域医学系<br />We report a case of completion pneumonectomy after 4 times of metastasectomy for metastatic lung tum
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ors from rectal carcinoma. A 63-year-old man underwent Miles' operation for advanced rectal carcinoma. Forty-seven months after the operation, bilateral metastasis was appeared, and bilateral metastasectomy was performed. After the resection, 3 times of metastasectomy were performed during 40 months. Follow-up X-ray and computed tomography (CT) showed abnormal shadow in his left hilum of lung. Completion pneumonectomy with mediastinal lymph node sampling was performed. He is still alive without recurrence 4 years after first thoracotomy. Repeated pulmonary resection can lead to good outcome for selective patients with metastatic colorectal carcinoma, and repeated surgery can be useful for pulmonary recurrences after thoracotomy.
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| 5.
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常塚, 宣男 ; Tsunezuka, Yoshio
概要:
取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1217号, 学位授与年月日：平成8年3月25日,学位授与年：1996
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常塚, 宣男
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金沢大学がん研究所<br />ヒト線維肉種HT1080細胞及びマウス肺癌細胞Madison-109細胞にMT-MMP-1及びAS-MT-MMP-1の遺伝子を発現させた後,マウスに移植して転移,増殖能に与える影響を実験転移アッセイ及び病理学的
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手法で検討した. 1)実験転移モデルにおいて2種類の細胞でMT-MMP-1遺伝子導入群(MT群)は発現ベクターのみの導入細胞群(対照群)に比べて,有意に肺生着率が高かった. 2)Madison109細胞の実験的肺転移における腫瘍移植後10日目の肺転移結節数は,MT群が対照群に比し約2倍と有意に多かった. 3)肺転移結節を形成している癌細胞の中でMT-MMP-1を発現しているMadison109細胞はMMP-2に対する免疫染色が陽性であった.以上の結果から,遺伝子導入により一過性に発現させたMT-MMP-1が活性化MMP-2を通じて癌細胞の実験的転移能,浸潤能及び増殖性を亢進させることが明らかとなった
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| 7.
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原, 丈介 ; 西, 耕一 ; 西川, 晋吾 ; 常塚, 宣男 ; 笠原, 寿郎 ; 藤村, 政樹
概要:
金沢大学医薬保健研究域医学系<br />背景．胸膜および肺に原発する滑膜肉腫は非常に稀である．症例．35歳，男性．右肺の異常陰影の精査目的に当院に紹介された．胸郭内原発の悪性腫瘍が疑われ，当院呼吸器外科にて胸腔鏡を行った．右胸腔内は脆弱な腫
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瘍で埋め尽くされていた．病理学的に，腫瘍は密に増殖する紡錘形細胞から成り，多数の核分裂像を認めた．免疫組織化学的検索を行ったが，確定診断には至らなかった．腫瘍は急速に増大し，約2ヶ月後に呼吸不全にて死亡した．剖検時，右肺は腫瘍により圧排され，虚脱していた．外科切除標本からRNAを抽出し，reverse transcription polymerase chain reaction（RT-PCR）を行い，さらにダイレクトシークエンスを行い，PCR産物がSYT-SSX2 融合遺伝子転写産物であることを確認した．胸膜以外に腫瘍を疑わせる所見を認めなかった．以上より，胸膜原発の滑膜肉腫と診断した．結論．非常に稀な腫瘍である胸膜原発の滑膜肉腫の1例を報告した．Background. Primary synovial sarcoma of the pleura and lung is extremely rare. Case. A 35-year-old man was admitted to our hospital because of an abnormal opacity in the right lung. A malignant intrathoracic tumor was suspected and a video-assisted thoracoscopic biopsy was performed. The right thoracic cavity was occupied by a fragile tumor. Histologically, the tumor showed dense proliferation of spindle cells with high rate of mitosis. Immunohistochemical examination was performed, but no definitive diagnosis was obtained. Progression of the tumor was very rapid and he died of respiratory failure 2 months after first presentation. On autopsy, the right lung was compressed and collapsed by the tumor. An SYT-SSX2 fusion gene transcript was detected by reverse transcription polymerase chain reaction (RT-PCR) and direct sequencing using RNA extracted from resected tissue specimens. There was no evidence of tumor except in the pleura. The final diagnosis was primary pleural synovial sarcoma. Conclusion. We report an extremely rare case of primary pleural synovial sarcoma. © 2010 The Japan Lung Cancer Society.
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上野, 恭一 ; 清水, 博志 ; 池田, 正寿 ; 常塚, 宣男 ; 佐藤, 日出夫 ; 車谷, 宏
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石川県立中央病院 核医学科<br />原著論文/症例報告
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| 9.
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伊藤, 祥隆 ; 小田, 誠 ; 太田, 安彦 ; 呉, 哲彦 ; 常塚, 宣男 ; 渡邊, 剛
概要:
金沢大学大学院医学系研究科血管病態制御学<br />症例は16歳, 男性.既往歴として4歳児に漏斗胸に対して胸骨翻転術を施行され, 14歳時にMarfan症候群と診断された.1994年に右自然気胸に対し胸腔鏡下肺部分切除術を施行した.199
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6年2月に右気胸を再発し保存的に加療したが, 同年4月に右気胸を再々発し, 小開胸下に肺部分切除術を施行した.1997年2月15日に左背部痛と呼吸困難が出現し, 当科を受診した.胸部レントゲン写真にて左自然気胸と診断した.胸腔ドレーンを留置して保存的に加療するも改善しないため, 2月20日胸腔鏡下手術を施行した.肺尖部にブラが多発しており, これを切除した.Marfan症候群は気胸の合併率が高く, 本例のように体格の成長に伴って気胸を繰り返し再発することもあり, 注意深い経過観察が必要と思われた. A case of bilateral recurrent pneumothrax in a patient with Marfan syndrome was reported. A 17-year-old male whose right pneumothorax had recurred twice during the past 3 years was admitted due to left pneumothorax complaining of chest pain and dyspnea. He was tall and thin with long tapered extremities, and echography revealed annulo-aortic ectasia. Air leakage continued inspite of left chest tube drainage followed by surgical treatment. Bullae were resected under VATS, and he was discharged 5 days later. Patients with Marfan syndrome should be observed carefully after operation because they frequently develop recurrent pneumothorax.
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| 10.
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太田, 安彦 ; 田村, 昌也 ; 飯野, 賢治 ; 常塚, 宣男 ; 新田, 香苗
概要:
癌性胸膜炎に対する腔内化学療法においては,長時間にわたる胸腔内での薬剤活性の維持が求められる.Paclitaxelの24時間胸腔内投与を含めた集学的治療の悪性胸水に対する治療成績につき中間報告する.方法.2001年10月から2004年5月ま
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でに,癌性胸膜炎と確診された10例に対して本治療を行なった.原発病巣は肺癌9例,乳癌1例.Paclitaxel(120 mg/m^2)24時間腔内投与を含む集学的治療を行なった.6例に対しては選択的に外科治療が,また9例に対しては全身化学療法が併用された.術式は肺部分切除+壁側胸膜切除(PL)2例,肺葉切除+PL2例,PL1例,胸壁切除+PL1例であった.結果.手術例においては術後平均7.7(3〜16)日目に腔内治療が施行された.Paclitaxel腔内投与に伴う副作用は10例中5例に認め,胸痛と白血球減少が頻度的には多かったが,重篤な副作用はみられず,5例においては副作用の発現は認めなかった.中間観察期間19ヶ月(3〜33ヶ月)にて,悪性胸水は8例において良好にコントロールされており,中間生存期間は18ヶ月であった.結語.症例数および観察期間ともなお蓄積が必要だが,paclitaxelを用いた長時間胸腔内治療は癌性胸膜炎に対する局所療法として新たな治療選択肢のひとつとなる可能性がある. Background. For successful intrapleural chemotherapy, efforts should be made to maintain the intrapleural drug activity as long as possible. In this interim report, the effectiveness of paclitaxel administered by 24-hour intrathoracic infusion as an adjunct to selective surgical management and/or systemic chemotherapy for controlling malignant pleural effusions is described. Methods. Between October 2001 and May 2004,10 patients with carcinomatous pleuritis were enrolled in the study. The primary sites of the diseases were the lung in 9 patients and the breast in one patient. Paclitaxel (120 mg/m^2) was administered by 24-hour intrathoracic infusion. Six of the 10 patients selectively underwent surgical treatment and 9 patients received adjuvant systemic chemotherapy. The operative procedures used were partial resection of the primary site plus parietal pleurectomy (PL) in 2 cases, lobectomy plus PL in 2 cases, PL only in one case, and chest wall resection plus PL in one case. Results. In patients who underwent surgery, the mean time interval between the operation and intrapleural chemotherapy was 7.7 days (range 3-16'days). Mild toxicity was found in 5 cases, and chest pain and neutropenia were dominant. During a median follow-up period of 19 months (range, 3-33 months), malignant effusions were successfully controlled in 8 patients and the median survival period was 18 months. Conclusion. The use of paclitaxel in this manner merits further investigation for possible intervention for malignant pleural effusions originating in lung and breast neoplasms.
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