超音波気管支鏡ガイド下針生検（EBUS-TBNA）により診断した肺腺癌と甲状腺乳頭癌の同時性重複癌の1例
背景．甲状腺癌と肺癌の同時性重複癌はしばしば報告されているが，画像所見のみでは甲状腺癌単独の肺転移と鑑別が困難なことがある．症例．76歳，女性．CTで甲状腺に石灰化を伴う腫瘤，多発肺結節を認め，穿刺細胞診の結果と合わせて甲状腺乳頭癌の多発遠隔転移と判断された．Positron emission tomography（PET）-CTでは，肺門および縦隔リンパ節，骨に異常集積を認めた．肺癌合併の可能性も考慮し，気管分岐下リンパ節に対してEBUS-TBNAを施行した．その結果，Napsin-A，EGFR遺伝子変異陽性の肺腺癌と診断され，甲状腺癌（cT2N1bM0/Stage II）と肺癌（cT4N3...
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| Published in | 気管支学 Vol. 41; no. 6; pp. 613 - 618 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器内視鏡学会
25.11.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0287-2137 2186-0149 |
| DOI | 10.18907/jjsre.41.6_613 |
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| Abstract | 背景．甲状腺癌と肺癌の同時性重複癌はしばしば報告されているが，画像所見のみでは甲状腺癌単独の肺転移と鑑別が困難なことがある．症例．76歳，女性．CTで甲状腺に石灰化を伴う腫瘤，多発肺結節を認め，穿刺細胞診の結果と合わせて甲状腺乳頭癌の多発遠隔転移と判断された．Positron emission tomography（PET）-CTでは，肺門および縦隔リンパ節，骨に異常集積を認めた．肺癌合併の可能性も考慮し，気管分岐下リンパ節に対してEBUS-TBNAを施行した．その結果，Napsin-A，EGFR遺伝子変異陽性の肺腺癌と診断され，甲状腺癌（cT2N1bM0/Stage II）と肺癌（cT4N3M1c/Stage IVB）の同時性重複癌と考えられた．アファチニブを開始したところ，甲状腺以外の病変は著明な縮小を認めた．結論．甲状腺乳頭癌に肺門あるいは縦隔リンパ節腫大が認められる場合，同部位へのEBUS-TBNAは肺癌との重複癌と甲状腺癌単独の肺転移を鑑別するのに有用な可能性がある． |
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| AbstractList | 背景．甲状腺癌と肺癌の同時性重複癌はしばしば報告されているが，画像所見のみでは甲状腺癌単独の肺転移と鑑別が困難なことがある．症例．76歳，女性．CTで甲状腺に石灰化を伴う腫瘤，多発肺結節を認め，穿刺細胞診の結果と合わせて甲状腺乳頭癌の多発遠隔転移と判断された．Positron emission tomography（PET）-CTでは，肺門および縦隔リンパ節，骨に異常集積を認めた．肺癌合併の可能性も考慮し，気管分岐下リンパ節に対してEBUS-TBNAを施行した．その結果，Napsin-A，EGFR遺伝子変異陽性の肺腺癌と診断され，甲状腺癌（cT2N1bM0/Stage II）と肺癌（cT4N3M1c/Stage IVB）の同時性重複癌と考えられた．アファチニブを開始したところ，甲状腺以外の病変は著明な縮小を認めた．結論．甲状腺乳頭癌に肺門あるいは縦隔リンパ節腫大が認められる場合，同部位へのEBUS-TBNAは肺癌との重複癌と甲状腺癌単独の肺転移を鑑別するのに有用な可能性がある． |
| Author | 九野, 貴華 新津, 敬之 谷崎, 智史 内田, 純二 上野, 清伸 柳瀬, 隆文 玄山, 宗到 北村, 貴裕 松本, 錦之介 伏見, 博彰 |
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| References | 5. Hassan A, Razi M, Riaz S, et al. Survival Analysis of Papillary Thyroid Carcinoma in Relation to Stage and Recurrence Risk: A 20-Year Experience in Pakistan. Clin Nucl Med. 2016;41:606-613. 9. 日本頭頸部癌学会, 編集. 頭頸部癌診療ガイドライン2018年版. 東京: 金原出版; 2018. 7. Wu K, Hou SM, Huang TS, et al. Thyroid carcinoma with bone metastases: a prognostic factor study. Clin Med Oncol. 2008;2:129-134. 2. Li F, Zhong WZ, Niu FY, et al. Multiple primary malignancies involving lung cancer. BMC Cancer. 2015;15:696. 6. Casara D, Rubello D, Saladini G, et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med. 1993;34:1626-1631. 3. Machens A, Dralle H. Correlation between the number of lymph node metastases and lung metastasis in papillary thyroid cancer. J Clin Endocrinol Metab. 2012;97:4375-4382. 4. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418-428. 10. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11:39-51. 12. Wang T, Blumer I, Boerner S, et al. Synchronous Papillary Carcinoma of Thyroid and Lung. Endocr Pathol. 2016;27:268-270. 1. Kim SW, Kong KA, Kim DY, et al. Multiple primary cancers involving lung cancer at a single tertiary hospital: Clinical features and prognosis. Thorac Cancer. 2015;6:159-165. 11. Hamada Y, Takise A, Uno D, et al. Synchronous primary triple cancers including the lung, stomach, and thyroid: a case report. Kyobu Geka. 2000;53:101-105. 13. Daniel D, Delumpa L, Bray N. Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter. Case Rep Med. 2015;2015:394958. 15. Cheng C, Zhou J, Shao X. Lung adenocarcinoma and pulmonary metastases coexist in a patient with papillary thyroid carcinoma: A case report. Medicine. 2017;96:e9078. 8. Katsenos S, Archondakis S. The value of radial probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymph node metastasis from primary papillary thyroid cancer. Diagn Cytopathol. 2016;44:748-752. 14. 多木誠人, 鈴木千晶, 馬庭 厚, ほか. 頸部リンパ節転移を同時に認めた甲状腺癌, 肺癌の二重癌の1例. 日本胸部臨床. 2011;70:1186-1192. |
| References_xml | – reference: 5. Hassan A, Razi M, Riaz S, et al. Survival Analysis of Papillary Thyroid Carcinoma in Relation to Stage and Recurrence Risk: A 20-Year Experience in Pakistan. Clin Nucl Med. 2016;41:606-613. – reference: 11. Hamada Y, Takise A, Uno D, et al. Synchronous primary triple cancers including the lung, stomach, and thyroid: a case report. Kyobu Geka. 2000;53:101-105. – reference: 6. Casara D, Rubello D, Saladini G, et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med. 1993;34:1626-1631. – reference: 9. 日本頭頸部癌学会, 編集. 頭頸部癌診療ガイドライン2018年版. 東京: 金原出版; 2018. – reference: 4. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418-428. – reference: 10. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11:39-51. – reference: 14. 多木誠人, 鈴木千晶, 馬庭 厚, ほか. 頸部リンパ節転移を同時に認めた甲状腺癌, 肺癌の二重癌の1例. 日本胸部臨床. 2011;70:1186-1192. – reference: 8. Katsenos S, Archondakis S. The value of radial probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymph node metastasis from primary papillary thyroid cancer. Diagn Cytopathol. 2016;44:748-752. – reference: 15. Cheng C, Zhou J, Shao X. Lung adenocarcinoma and pulmonary metastases coexist in a patient with papillary thyroid carcinoma: A case report. Medicine. 2017;96:e9078. – reference: 7. Wu K, Hou SM, Huang TS, et al. Thyroid carcinoma with bone metastases: a prognostic factor study. Clin Med Oncol. 2008;2:129-134. – reference: 13. Daniel D, Delumpa L, Bray N. Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter. Case Rep Med. 2015;2015:394958. – reference: 1. Kim SW, Kong KA, Kim DY, et al. Multiple primary cancers involving lung cancer at a single tertiary hospital: Clinical features and prognosis. Thorac Cancer. 2015;6:159-165. – reference: 3. Machens A, Dralle H. Correlation between the number of lymph node metastases and lung metastasis in papillary thyroid cancer. J Clin Endocrinol Metab. 2012;97:4375-4382. – reference: 12. Wang T, Blumer I, Boerner S, et al. Synchronous Papillary Carcinoma of Thyroid and Lung. Endocr Pathol. 2016;27:268-270. – reference: 2. Li F, Zhong WZ, Niu FY, et al. Multiple primary malignancies involving lung cancer. BMC Cancer. 2015;15:696. |
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| Snippet | 背景．甲状腺癌と肺癌の同時性重複癌はしばしば報告されているが，画像所見のみでは甲状腺癌単独の肺転移と鑑別が困難なことがある．症例．76歳，女性．CTで甲状腺に石灰... |
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| SubjectTerms | 甲状腺乳頭癌 縦隔リンパ節転移 肺腺癌 超音波気管支鏡ガイド下針生検 |
| Title | 超音波気管支鏡ガイド下針生検（EBUS-TBNA）により診断した肺腺癌と甲状腺乳頭癌の同時性重複癌の1例 |
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