内容紹介
Summary
Case: Right pleural effusion was detected on chest X-ray performed prior to surgery for a right inguinal hernia in a 63-year-old man. Adenocarcinoma was diagnosed based on pleural effusion cytology results. A CT scan revealed mediastinal lymphadenopathy and pleural dissemination, but no obvious lung tumor; other examinations also did not reveal a primary tumor. We, therefore, diagnosed primary lung cancer(c-TxN2M1a, Stage ⅣA, according to the General Rules for Clinical and Pathological Record of Lung Cancer, 8th edition). An abdominal aortic aneurysm was also observed on CT. Since he was diagnosed with EGFR-negative lung cancer with malignant pleural effusion, we selected chemotherapy with cisplatin, pemetrexed, and bevacizumab(CDDP/PEM/Bev)and administered 2 courses without problems. He experienced no adverse events during the 3rd course and was discharged on day 8. However, he was transported to our emergency room at 20: 45 on treatment day 10 when he developed abdominal pain and nearly fainted. An abdominal aortic rupture was diagnosed by CT, and he was transported to another hospital because he could not be treated at our hospital. Information that this patient had been treated with Bev was not provided to the doctor on duty, and abdominal aortic graft replacement was immediately performed. The patient had a good postoperative course without anastomotic leakage and was discharged on day 7 after surgery. Bev is a monoclonal antibody for vascular endothelial growth factor. Conclusion: We report that this drug, bevacizumab, may be associated with abdominal aortic rupture.
要旨
症例は63歳,男性。現病歴: 右鼠経ヘルニア術前の胸部X線にて右胸水を指摘された。胸水細胞診で腺癌と診断したが,CTで縦隔リンパ節腫大,胸膜播種は認めたが肺腫瘍は指摘できず,他検査でも原発巣は認めず原発性肺癌,c-TxN2M1a,Stage ⅣAと診断した。診断時CTで腹部大動脈瘤も認めた。EGFR遺伝子陰性,悪性胸水合併よりシスプラチン(CDDP)+ペメトレキセド(PEM)+ベバシズマブ(Bev)による化学療法を行った。3コース目投与後10日目,トイレ時に腹痛,意識もうろうとなり救急外来に搬送された。CTで腹部大動脈瘤破裂と診断したが,当院では対応できず他院搬送となった。しかしBev投与後という情報提供がなされず,搬送後緊急腹部大動脈人工血管置換術が行われた。経過は良好で術後第7病日に退院となった。結論: Bevは血管内皮増殖因子に対するモノクローナル抗体であり,腹部大動脈瘤破裂に関連した可能性があり報告する。
目次
Case: Right pleural effusion was detected on chest X-ray performed prior to surgery for a right inguinal hernia in a 63-year-old man. Adenocarcinoma was diagnosed based on pleural effusion cytology results. A CT scan revealed mediastinal lymphadenopathy and pleural dissemination, but no obvious lung tumor; other examinations also did not reveal a primary tumor. We, therefore, diagnosed primary lung cancer(c-TxN2M1a, Stage ⅣA, according to the General Rules for Clinical and Pathological Record of Lung Cancer, 8th edition). An abdominal aortic aneurysm was also observed on CT. Since he was diagnosed with EGFR-negative lung cancer with malignant pleural effusion, we selected chemotherapy with cisplatin, pemetrexed, and bevacizumab(CDDP/PEM/Bev)and administered 2 courses without problems. He experienced no adverse events during the 3rd course and was discharged on day 8. However, he was transported to our emergency room at 20: 45 on treatment day 10 when he developed abdominal pain and nearly fainted. An abdominal aortic rupture was diagnosed by CT, and he was transported to another hospital because he could not be treated at our hospital. Information that this patient had been treated with Bev was not provided to the doctor on duty, and abdominal aortic graft replacement was immediately performed. The patient had a good postoperative course without anastomotic leakage and was discharged on day 7 after surgery. Bev is a monoclonal antibody for vascular endothelial growth factor. Conclusion: We report that this drug, bevacizumab, may be associated with abdominal aortic rupture.
要旨
症例は63歳,男性。現病歴: 右鼠経ヘルニア術前の胸部X線にて右胸水を指摘された。胸水細胞診で腺癌と診断したが,CTで縦隔リンパ節腫大,胸膜播種は認めたが肺腫瘍は指摘できず,他検査でも原発巣は認めず原発性肺癌,c-TxN2M1a,Stage ⅣAと診断した。診断時CTで腹部大動脈瘤も認めた。EGFR遺伝子陰性,悪性胸水合併よりシスプラチン(CDDP)+ペメトレキセド(PEM)+ベバシズマブ(Bev)による化学療法を行った。3コース目投与後10日目,トイレ時に腹痛,意識もうろうとなり救急外来に搬送された。CTで腹部大動脈瘤破裂と診断したが,当院では対応できず他院搬送となった。しかしBev投与後という情報提供がなされず,搬送後緊急腹部大動脈人工血管置換術が行われた。経過は良好で術後第7病日に退院となった。結論: Bevは血管内皮増殖因子に対するモノクローナル抗体であり,腹部大動脈瘤破裂に関連した可能性があり報告する。