内容紹介
Summary
Background: Concomitant myocardial and cutaneous metastases of squamous cell lung cancer after left pneumonectomy are very rare. Although nivolumab is used as a standard second-line chemotherapy for non-small cell lung cancer(NSCLC), its efficacy for concomitant myocardial and cutaneous metastases remains unclear. Case: A 66-year-old man with no chief complaints was diagnosed with myocardial metastasis by CT scan. The patient underwent radical left pneumonectomy for squamous cell lung cancer 12 months previously and had rejected adjuvant chemotherapy with pT2aN1M0-ⅡB(7th edition). A skin lesion in the left side of the neck was diagnosed as cutaneous metastasis by cytological examination. First-line treatment with cisplatin plus gemcitabine was administered; it was then replaced with nivolumab as a second-line chemotherapy after the progression of the disease due to myocardial metastasis. Fortunately, after 5 courses of nivolumab, there was a reduction in the cutaneous metastasis, which allowed complete resection, and reduction in the volume of myocardial metastasis. The patient is alive 30 months after left pneumonectomy and 18 months after the diagnosis of relapse. Nivolumab treatment is on-going. Conclusion: Complete resection of a cutaneous metastasis of squamous cell lung cancer and a reduction in the volume of myocardial metastasis were achieved following nivolumab treatment. Thus, nivolumab is a useful chemotherapy for concomitant cutaneous and myocardial metastases of squamous cell lung cancer.
要旨
症例は66歳,男性。原発性肺扁平上皮癌の診断で左肺全摘術+ND2a2+心膜合併切除術を施行し完全切除し得た。病理病期はT2aN1M0-ⅡB(7th edition)であった。術後1年目の全身computed tomography(CT)で心筋転移を認め,さらに左頸部の硬結は転移性皮膚腫瘍の診断となった。一次治療としてcisplatin+gemcitabine 2コース後に心筋転移巣が増大を認めたため,二次治療としてnivolumabを開始した。5コース後は心筋・皮膚転移巣の縮小を認めたが,自壊・異臭を認めていたため単発皮膚病変を切除した。現在も術後30か月でnivolumab継続中である。左肺全摘後に心筋・皮膚転移を生前に診断し,nivolumab投与により皮膚病変を切除し得たまれな1例を経験した。
目次
Background: Concomitant myocardial and cutaneous metastases of squamous cell lung cancer after left pneumonectomy are very rare. Although nivolumab is used as a standard second-line chemotherapy for non-small cell lung cancer(NSCLC), its efficacy for concomitant myocardial and cutaneous metastases remains unclear. Case: A 66-year-old man with no chief complaints was diagnosed with myocardial metastasis by CT scan. The patient underwent radical left pneumonectomy for squamous cell lung cancer 12 months previously and had rejected adjuvant chemotherapy with pT2aN1M0-ⅡB(7th edition). A skin lesion in the left side of the neck was diagnosed as cutaneous metastasis by cytological examination. First-line treatment with cisplatin plus gemcitabine was administered; it was then replaced with nivolumab as a second-line chemotherapy after the progression of the disease due to myocardial metastasis. Fortunately, after 5 courses of nivolumab, there was a reduction in the cutaneous metastasis, which allowed complete resection, and reduction in the volume of myocardial metastasis. The patient is alive 30 months after left pneumonectomy and 18 months after the diagnosis of relapse. Nivolumab treatment is on-going. Conclusion: Complete resection of a cutaneous metastasis of squamous cell lung cancer and a reduction in the volume of myocardial metastasis were achieved following nivolumab treatment. Thus, nivolumab is a useful chemotherapy for concomitant cutaneous and myocardial metastases of squamous cell lung cancer.
要旨
症例は66歳,男性。原発性肺扁平上皮癌の診断で左肺全摘術+ND2a2+心膜合併切除術を施行し完全切除し得た。病理病期はT2aN1M0-ⅡB(7th edition)であった。術後1年目の全身computed tomography(CT)で心筋転移を認め,さらに左頸部の硬結は転移性皮膚腫瘍の診断となった。一次治療としてcisplatin+gemcitabine 2コース後に心筋転移巣が増大を認めたため,二次治療としてnivolumabを開始した。5コース後は心筋・皮膚転移巣の縮小を認めたが,自壊・異臭を認めていたため単発皮膚病変を切除した。現在も術後30か月でnivolumab継続中である。左肺全摘後に心筋・皮膚転移を生前に診断し,nivolumab投与により皮膚病変を切除し得たまれな1例を経験した。