気胸、肺嚢胞性病変をおこす肺血管肉腫/ジンとスダチは果たしてあうか?
線と胸部CTでは,右上葉S1に50×45mm大の腫瘤を認めた.気管支鏡下生検で肺癌との診断を得たため,平成11年1月26日,右上葉切除+リンパ節廓清術を施行した.腫瘍は,60×50mm大で,病理組織学的検査では,腫瘍は大小 不同の異型細胞よりなり,著明な管腔形成を認めた.鍍銀染色とFactor VIII,CD34の免疫組織染色にて,肺血管肉腫との診断を得た.根治術を行うことができた症例であるが,術後6カ月目に多発性骨転移にて死亡した.本症例 は,稀な疾患で,本邦報告例は,自験例を含めた11例であった.
Metastatic Angiosarcoma of the Scalp Presenting with Cystic Lung Lesions: A Case Report and Review of Cystic Lung Diseases
Abstract
INTRODUCTION:
Angiosarcomas are rare, malignant vascular tumors that affect endothelial cells of blood vessels. Angiosarcomas most commonly occur on the scalp or face of elderly individuals and are highly aggressive, with a 5-year survival rate below 15%. Cutaneous angiosarcomas often metastasize to the lung, where they can present with cystic lesions, solid lesions, pneumothorax, and/or hemothorax.
CASE PRESENTATION:
We report the case of an 83-year-old woman who presented with a scalp lesion, which was initially thought to be caused by scalp trauma but was later found to be an angiosarcoma. She initially refused any therapy for the tumor. She returned several months later with a cough and shortness of breath and was found to have multiple pulmonary cysts. She was treated with paclitaxel, but her tumor did not respond to the therapy and she died 2 months later.
DISCUSSION:
We discuss the common presentation of cutaneous angiosarcomas and their tendency to metastasize to the lung and present as cystic lesions. We also review the common conditions that can cause cystic changes in the lungs.
・肺血管腫のCT所見をまとめた文献が↓(残念ながら無料ではみられないので、わたしは抄録しか読んでません)
Pulmonary metastases from angiosarcoma: a spectrum of CT findings
Abstract
Background
Though a few reports have summarized the computed tomography (CT) findings of pulmonary metastases from angiosarcoma, the detailed CT findings of cysts are not well known, except for their characteristic thin walls.
Purpose
To retrospectively summarize the CT findings of pulmonary metastases from angiosarcoma, focusing mainly on the CT findings of cysts.
Material and Methods
Thirty-three patients with pulmonary metastases from angiosarcoma were selected retrospectively. Two radiologists reviewed and assessed patients’ chest CT images on a consensus basis for nodules, cysts, the CT halo sign, pneumothorax, pleural effusion, and enlarged lymph nodes. Cysts were also evaluated by wall thickness and smoothness, air-fluid levels, and vessels or bronchi penetrating the cysts. The relationship between cysts and pneumothorax was assessed using the Chi-square test.
Results
Nodules were found in 28 (85%) patients. Cysts were found in 19 (58%) patients; 17 had thin and smooth walls, 10 had thin and irregular walls, and four had thick and irregular walls. In addition, 12 patients showed vessels or bronchi penetrating the cysts, and six showed air-fluid levels. The CT halo sign, pneumothorax, pleural effusion, and mediastinal lymphadenopathy were seen in 19 (58%), 16 (48%), 26 (78.8%), and five (15.2%) patients, respectively. Pneumothorax occurred significantly more frequently in patients with cysts (P = 0.002).
Conclusion
Cysts showed variability in their walls, and air-fluid levels and vessels or bronchi penetrating the cysts appeared to be characteristic findings, which may be useful for detection and accurate diagnosis in patients with pulmonary metastases from angiosarcoma.
・当然?、結節影も呈するわけですが、気胸や嚢胞性病変は一応血管肉腫も鑑別診断にいれないといけないですね。(鑑別診断の上位にはならないでしょうが)
以下日記
・昨日11/14は魔の水曜日で、ようブログをアップできませんした。昨日はというと午前外来、午後産業医面談、病棟カンファレンス、夜間診療でした。そして当直。幸い真夜中に起こされることはありませんでした。
・本日11/15(木)は、5時半に病棟のNs.より電話で起こされました。カルテに指示を入れるだけだったのですが、その後寝付けず結局6時過ぎにベッドからでて行動開始。まずは、シャワーをあびて事務作業。朝食摂って、一服後病棟の回診。それから朝礼でて午前外来。午後回診、ご家族と面談、業者さんと面談。で、18時に病院を出て、帰宅途中にある熟女と「公園」で逢引きし、あるものをいただいて帰宅。で、録画の「マツコの知らない世界」(新大久保のグルメの話)を観ながら夕食。(いまだかって新大久保に行ったことないので、いってみたい。)で、例によって夕食でおなかいっぱいで動けないのでこのブログかいています。これから入浴。そして、まちにまったアルコール摂取。今日はジントニックもどきで、ライムの代わりにスダチをつかってみたいと思います。果たして、マッチするでしょうか?・・・って、そういうの作っている人すでにいますね。ミチバの法則:自分がかんがえることは、たいてい他の人も考えている。
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