A case of unclassified lung carcinoma diagnosed after the treatment for small cell lung carcinoma

小細胞肺癌治療後に発生した同一肺葉内病変が分類不能癌と診断された1例

A case of unclassified lung carcinoma diagnosed after the treatment for small cell lung carcinoma

Creators Yoshimine Sota

Creators Murakami Junichi

Creators Sano Fumiho

Creators Hayashi Masataro

Creators Ueda Kazuhiro

Creators Hamano Kimikazu

【背景】小細胞肺癌治療後の同一肺葉内病変を切除し分類不能癌と診断された1例を報告する.【症例】60歳代の男性.右肺下葉S8原発の小細胞肺癌Stage III A(T1bN2M0)に対して放射線化学療法が行われ,完全寛解となった.2年後に同一肺葉のS10に腫瘤が出現し,16ヵ月間にわたって化学療法が行われた.縮小と増大を繰り返し,最終的に治療抵抗性となったため当科紹介となった.右肺下葉S10に25×25mm大の腫瘍性病変を認めた.縦隔･肺門リンパ節や遠隔臓器への転移を疑う所見はなかった.小細胞肺癌の同一肺葉内再発と考えられるが,化学療法抵抗性で他に有効な治療法がないことから右下葉切除術ND2a-1を施行した.病理検査で分類不能癌と診断された.術後29ヵ月の現在,再発を認めない.【結論】小細胞肺癌に対する内科的治療抵抗性となった時点で救済手術を意図して右下葉切除術を行ったが,病理診断は分類不能癌であった.第2癌または再発の両観点から考察する.

【Background】We report a case of unclassified lung carcinoma diagnosed after the treatment for small cell lung carcinoma.【Case】The patient is a man of 60 years old. The patient was treated with systemic chemoradiotherapy for small cell lung carcinoma developed in the right lower lobe S8(T1bN2M0).Regardless of achieving complete remission, the patient developed metachronous solitary lung nodule in the same lobe(S10).The nodule could be controlled for 16 months by chemotherapy against small cell carcinoma. Because the nodule became to be chemotherapy-resistant, the patient underwent surgery. Postoperative pathological examination revealed features of being unclassified carcinoma of the lung. The patient is aliving without recurrence 29 months after the operation.【Conclusion】Although it remains unknown whether the secondary lung lesion is metastatic or second primary lesion, surgery played a role as a curative intent treatment.

[ISSN]0513-1731

[NCID]AN00243156