内容紹介
Summary
Pulmonary enteric adenocarcinoma is a unique pulmonary adenocarcinoma subtype and has histopathological findings that are similar to those of colorectal adenocarcinoma. A man in his 50s visited our hospital because of discomfort in his right lower leg for the last 9 months. Imaging studies revealed a mass in his right soleus muscle, and needle biopsy was performed. Histological findings revealed adenocarcinoma, and immunohistochemical staining showed that the tumor cells were positive for CK20 and CDX-2. The tumor was first suspected to be metastasis of gastrointestinal malignant tumors. FDG-PET/CT showed increased FDG uptake in the right soleus muscle mass and presented with increased FDG uptake in a right upper lobe mass and right mediastinum lymphadenopathy. There were no findings in other organs. Scraping cytology of a transbronchial biopsy indicated adenocarcinoma. Upper and lower gastrointestinal endoscopy showed no findings of malignancy. He was finally diagnosed with pulmonary enteric adenocarcinoma(cT3N2M1b, Stage ⅣA). Treatment with cisplatin(CDDP), pemetrexed(PEM), and bevacizumab(BEV) was initiated. After 4 courses of the regimen, the tumor was partially reduced, and the patient showed stable disease(SD).
要旨
症例は50歳代,男性。X-1年6月ごろより右下腿の違和感が出現し,X年3月に当院を受診した。画像検査で右ヒラメ筋内の腫瘤を指摘,X年4月に針生検を施行されadenocarcinomaと診断。免疫染色にてCK20,CDX-2が陽性で,大腸癌など消化管悪性腫瘍の転移の可能性がまず考えられた。FDG-PET/CTでは右肺尖部腫瘤と右縦隔リンパ節の腫大を認め,右ヒラメ筋とともにFDG集積を伴い原発性肺癌も疑われた。同月,呼吸器内科を受診し,右上葉病変に対する擦過細胞診でadenocarcinomaの診断を得た。上部・下部消化管内視鏡検査で異常所見を認めず腸型肺腺癌(cT3N2M1b,Stage ⅣA)と考え,cisplatin(CDDP)+pemetrexed(PEM)+bevacizumab(BEV)を施行した。4コース終了時点で病変は縮小傾向を示し,stable disease(SD)を維持している。
目次
Pulmonary enteric adenocarcinoma is a unique pulmonary adenocarcinoma subtype and has histopathological findings that are similar to those of colorectal adenocarcinoma. A man in his 50s visited our hospital because of discomfort in his right lower leg for the last 9 months. Imaging studies revealed a mass in his right soleus muscle, and needle biopsy was performed. Histological findings revealed adenocarcinoma, and immunohistochemical staining showed that the tumor cells were positive for CK20 and CDX-2. The tumor was first suspected to be metastasis of gastrointestinal malignant tumors. FDG-PET/CT showed increased FDG uptake in the right soleus muscle mass and presented with increased FDG uptake in a right upper lobe mass and right mediastinum lymphadenopathy. There were no findings in other organs. Scraping cytology of a transbronchial biopsy indicated adenocarcinoma. Upper and lower gastrointestinal endoscopy showed no findings of malignancy. He was finally diagnosed with pulmonary enteric adenocarcinoma(cT3N2M1b, Stage ⅣA). Treatment with cisplatin(CDDP), pemetrexed(PEM), and bevacizumab(BEV) was initiated. After 4 courses of the regimen, the tumor was partially reduced, and the patient showed stable disease(SD).
要旨
症例は50歳代,男性。X-1年6月ごろより右下腿の違和感が出現し,X年3月に当院を受診した。画像検査で右ヒラメ筋内の腫瘤を指摘,X年4月に針生検を施行されadenocarcinomaと診断。免疫染色にてCK20,CDX-2が陽性で,大腸癌など消化管悪性腫瘍の転移の可能性がまず考えられた。FDG-PET/CTでは右肺尖部腫瘤と右縦隔リンパ節の腫大を認め,右ヒラメ筋とともにFDG集積を伴い原発性肺癌も疑われた。同月,呼吸器内科を受診し,右上葉病変に対する擦過細胞診でadenocarcinomaの診断を得た。上部・下部消化管内視鏡検査で異常所見を認めず腸型肺腺癌(cT3N2M1b,Stage ⅣA)と考え,cisplatin(CDDP)+pemetrexed(PEM)+bevacizumab(BEV)を施行した。4コース終了時点で病変は縮小傾向を示し,stable disease(SD)を維持している。