内容紹介
Summary
A 65-year-old woman who had diabetes mellitus was referred to the Department of Diabetes Internal Medicine of our hospital in June 201X due to disease progression. Chest radiography revealed an abnormal shadow, and computed tomography (CT) showed a 2 cm nodular shadow in the right S10. Lung cancer was suspected because of increased serum progastrin-releasing peptide(ProGRP)level and smoking history. She was referred to our department and was diagnosed with carcinoid on transbronchial biopsy. After 1 month, CT demonstrated regression of the carcinoid and improved serum ProGRP level. After more than 1 month, the carcinoid size did not change, and serum ProGRP level slightly increased. We expected that it would be difficult for the carcinoid to regress. After glycemic control was improved, the patient underwent right lower lobectomy via video-assisted thoracoscopy. In the resected specimen, the border of carcinoid was clear. She was diagnosed with a typical carcinoid. The carcinoid was not accompanied by inflammation or necrotic tissue. A carcinoid is a low-grade malignant tumor and does not usually regress spontaneously. However, in this case, it regressed spontaneously.
要旨
症例は65歳,女性。糖尿病の血糖コントロールが悪化したため,201X年6月当院糖尿病内科に紹介となった。初診時の胸部単純X線撮影にて肺野に異常陰影を指摘,さらにCT上で右S10に2 cm大の結節を認めた。progastrin-releasing peptide(ProGRP)が高値であり,喫煙歴があることから肺癌の疑いにて当科紹介となった。 気管支鏡検査にてカルチノイドと診断されたが,無治療にもかかわらず1か月後のCTで結節は縮小しProGRPも低下した。さらに1か月後,結節のサイズは著変なかったがProGRPが微増しており,血糖値も改善したため胸腔鏡補助下右肺下葉切除術を施行した。定型的カルチノイドと確定診断された。周囲との境界は明瞭で壊死組織や周囲に炎症像は認められなかった。カルチノイドは低悪性度の腫瘍であり通常自然退縮は期待できないとされているが, 今回われわれは自然縮小したカルチノイドの1例を経験した。
目次
A 65-year-old woman who had diabetes mellitus was referred to the Department of Diabetes Internal Medicine of our hospital in June 201X due to disease progression. Chest radiography revealed an abnormal shadow, and computed tomography (CT) showed a 2 cm nodular shadow in the right S10. Lung cancer was suspected because of increased serum progastrin-releasing peptide(ProGRP)level and smoking history. She was referred to our department and was diagnosed with carcinoid on transbronchial biopsy. After 1 month, CT demonstrated regression of the carcinoid and improved serum ProGRP level. After more than 1 month, the carcinoid size did not change, and serum ProGRP level slightly increased. We expected that it would be difficult for the carcinoid to regress. After glycemic control was improved, the patient underwent right lower lobectomy via video-assisted thoracoscopy. In the resected specimen, the border of carcinoid was clear. She was diagnosed with a typical carcinoid. The carcinoid was not accompanied by inflammation or necrotic tissue. A carcinoid is a low-grade malignant tumor and does not usually regress spontaneously. However, in this case, it regressed spontaneously.
要旨
症例は65歳,女性。糖尿病の血糖コントロールが悪化したため,201X年6月当院糖尿病内科に紹介となった。初診時の胸部単純X線撮影にて肺野に異常陰影を指摘,さらにCT上で右S10に2 cm大の結節を認めた。progastrin-releasing peptide(ProGRP)が高値であり,喫煙歴があることから肺癌の疑いにて当科紹介となった。 気管支鏡検査にてカルチノイドと診断されたが,無治療にもかかわらず1か月後のCTで結節は縮小しProGRPも低下した。さらに1か月後,結節のサイズは著変なかったがProGRPが微増しており,血糖値も改善したため胸腔鏡補助下右肺下葉切除術を施行した。定型的カルチノイドと確定診断された。周囲との境界は明瞭で壊死組織や周囲に炎症像は認められなかった。カルチノイドは低悪性度の腫瘍であり通常自然退縮は期待できないとされているが, 今回われわれは自然縮小したカルチノイドの1例を経験した。