A case of metachronous multiple lung cancers with large cell carcinoma with neuroendocrine morphology and adenosquamous carcinoma

背 景:原発性肺癌の組織型でadenosquamous carcinoma(Adsq)とlarge cell carcinoma with neuroendocrine morphology(LCCNM)はともに頻度が少なく,それらを異時性に合併した症例の報告は認められない.症 例:80歳の男性.65歳時に喉頭癌で,喉頭全摘術が行われた.喉頭癌の術前CTで右肺中葉と下葉に結節を認められていたため,肺部分切除が行われたが,結果は良性結節であった.その7年後,右肺上葉と中葉と下葉のそれぞれに計3個の肺結節が認められ,喉頭癌の転移が疑われ,肺部分切除が行われたが,すべてがLCCNMであり,LCCNMの他肺葉転移の可能性が高いと診断された.さらに3年後,右肺上葉に再び結節が認められたため,肺部分切除が行われたが,今度はAdsqであった.その5年後に右肺下葉に結節影が認められ,4度目の手術が行われた.病理結果はAdsqであった.結 論:LCCNMとAdsqからなる稀な異時性多発肺癌を複数回の胸腔鏡下手術(VATS)を含む集学的治療により長期生存が得られた.

Background:Adenosquamous carcinoma(Adsq)and large cell carcinoma with neuroendocrine morphology(LCCNM)are rare histologic types of primary lung cancer. The metachronous occurrence of these types has not been reported previously in Japan. Case:A man in 80s had undergone whole larynx enucleation for laryngeal cancer when he was in 60s. Partial lung resection was performed because a nodular shadow was detected in the middle and lower lobes of the right lung on chest computed tomography(CT)before the laryngeal surgery, but the nodules were found to be benign. Seven years later, CT showed a nodular shadow in all lobes of the right lung. On suspicion of metastatic laryngeal cancer, partial lung resection was performed. However, all the nodules were histopathologically diagnosed with LCCNM. Three years thereafter, partial lung resection was performed again because of a nodular shadow in the upper lobe of the right lung on CT. The nodule was histopathologically classified as Adsq. Five years later, a fourth lung operation was performed because of a nodular shadow in the lower lobe of the right lung on CT, which was diagnosed as Adsq.Conclusion:We report a rare case who got long-term survival by lung operation of metachronous multiple lung cancers with LCCNM and Adsq.

多発肺癌

腺扁平上皮癌

大細胞癌