内容紹介
Summary
A 54-year-old woman had a history of precordial pain since February 20XX and had undergone a clinical examination at a nearby medical clinic in April 20XX. Because a plain chest radiograph revealed a mass shadow, the patient was referred to us for medical evaluation. Chest computerized tomography(CT)revealed a mass measuring 12 cm in size along its major axis diameter in the anterior mediastinal region, along with the enlargement of the anterior mediastinal, parasternal, hilar, and supradiaphragmatic lymph nodes, suggesting a thymic tumor. Histopathological examination of a needle biopsy specimen revealed a carcinoid. Thus, the patient was diagnosed with a primary thymic carcinoid. The patient was treated by partial excision of the mediastinal tumor owing to the presence of pericardial dissemination. Because of the histopathologic diagnosis of atypical carcinoid, the patient was additionally administered everolimus therapy in May. A repeat CT in July revealed shrinkage of the mass, but a subsequent CT in November revealed slight enlargement of the tumor. Because the somatostatin receptor(SSTR-2)tested positive, concomitant octreotide acetate injection was initiated in December. Follow-up CT examinations revealed stabilization of the disease at first. However, the gradual enlargement of the tumor was noted thereafter. This case constitutes one of the few reports of the treatment of primary thymic carcinoid with everolimus and octreotide.
要旨
症例は54歳,女性。X年2月から前胸部痛があり,4月に近医を受診された。胸部X線で腫瘤影を認め,当院に紹介され受診した。CTで前縦隔に長径12 cm大の腫瘤,前縦隔・傍胸骨・肺門・横隔膜上リンパ節の腫大を認め,胸腺腫瘍が疑われた。腫瘤の針生検の病理診断はカルチノイドで胸腺原発カルチノイドと診断,手術を行ったが心膜播種があり縦隔腫瘍の一部を摘出して終了した。病理では非定型カルチノイドの診断で5月からエベロリムスで治療を開始したところ,CTでの腫瘤は7月には縮小したが11月には軽度増大した。ソマトスタチンレセプター(SSTR-2)が陽性であり,12月からオクトレオチドの注射を併用しCTでしばらく病勢安定を維持していたが緩徐に増大した。胸腺原発カルチノイドに対するエベロリムスとオクトレオチドを使用した報告は少ないため報告する。
目次
A 54-year-old woman had a history of precordial pain since February 20XX and had undergone a clinical examination at a nearby medical clinic in April 20XX. Because a plain chest radiograph revealed a mass shadow, the patient was referred to us for medical evaluation. Chest computerized tomography(CT)revealed a mass measuring 12 cm in size along its major axis diameter in the anterior mediastinal region, along with the enlargement of the anterior mediastinal, parasternal, hilar, and supradiaphragmatic lymph nodes, suggesting a thymic tumor. Histopathological examination of a needle biopsy specimen revealed a carcinoid. Thus, the patient was diagnosed with a primary thymic carcinoid. The patient was treated by partial excision of the mediastinal tumor owing to the presence of pericardial dissemination. Because of the histopathologic diagnosis of atypical carcinoid, the patient was additionally administered everolimus therapy in May. A repeat CT in July revealed shrinkage of the mass, but a subsequent CT in November revealed slight enlargement of the tumor. Because the somatostatin receptor(SSTR-2)tested positive, concomitant octreotide acetate injection was initiated in December. Follow-up CT examinations revealed stabilization of the disease at first. However, the gradual enlargement of the tumor was noted thereafter. This case constitutes one of the few reports of the treatment of primary thymic carcinoid with everolimus and octreotide.
要旨
症例は54歳,女性。X年2月から前胸部痛があり,4月に近医を受診された。胸部X線で腫瘤影を認め,当院に紹介され受診した。CTで前縦隔に長径12 cm大の腫瘤,前縦隔・傍胸骨・肺門・横隔膜上リンパ節の腫大を認め,胸腺腫瘍が疑われた。腫瘤の針生検の病理診断はカルチノイドで胸腺原発カルチノイドと診断,手術を行ったが心膜播種があり縦隔腫瘍の一部を摘出して終了した。病理では非定型カルチノイドの診断で5月からエベロリムスで治療を開始したところ,CTでの腫瘤は7月には縮小したが11月には軽度増大した。ソマトスタチンレセプター(SSTR-2)が陽性であり,12月からオクトレオチドの注射を併用しCTでしばらく病勢安定を維持していたが緩徐に増大した。胸腺原発カルチノイドに対するエベロリムスとオクトレオチドを使用した報告は少ないため報告する。