アプローチに工夫を要した左肺尖部巨大肋骨原発線維性骨異形成の1例
58歳，男性．左前胸部の硬結を主訴に受診した．胸部CTで左第2肋骨より発生し肺尖部を占拠する径12×9 cmの腫瘤を認め，PET-CTで同部位にFDG異常集積を伴っていた．CTガイド下生検で線維性骨異形成の診断となり手術の方針となった．アプローチは先に後側方切開で行い，その後，仰臥位で前方L字型切開を追加し，腫瘍を含めた第1，2，3肋骨切除術を施行した．術後病理検査でも線維性骨異形成の診断で，悪性転化は認めなかった．肋骨原発線維性骨異形成は巨大化することがあり，また上位肋骨発生の症例では切除に難渋することもある．通常の肺尖部肺癌とは異なり骨性胸郭外にも腫瘍が大きく進展するため，術中に鎖骨下腔の...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 39; no. 6; pp. 488 - 494 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本呼吸器外科学会
15.09.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.39.488 |
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| Abstract | 58歳，男性．左前胸部の硬結を主訴に受診した．胸部CTで左第2肋骨より発生し肺尖部を占拠する径12×9 cmの腫瘤を認め，PET-CTで同部位にFDG異常集積を伴っていた．CTガイド下生検で線維性骨異形成の診断となり手術の方針となった．アプローチは先に後側方切開で行い，その後，仰臥位で前方L字型切開を追加し，腫瘍を含めた第1，2，3肋骨切除術を施行した．術後病理検査でも線維性骨異形成の診断で，悪性転化は認めなかった．肋骨原発線維性骨異形成は巨大化することがあり，また上位肋骨発生の症例では切除に難渋することもある．通常の肺尖部肺癌とは異なり骨性胸郭外にも腫瘍が大きく進展するため，術中に鎖骨下腔の視野の展開が困難となることが予想される．このため，前方L字型切開を併用するアプローチを用いる場合には注意を要する．一方，悪性転化や胸郭出口症候群の併発も報告されているため，積極的に手術を行うべきである． |
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| AbstractList | 58歳，男性．左前胸部の硬結を主訴に受診した．胸部CTで左第2肋骨より発生し肺尖部を占拠する径12×9 cmの腫瘤を認め，PET-CTで同部位にFDG異常集積を伴っていた．CTガイド下生検で線維性骨異形成の診断となり手術の方針となった．アプローチは先に後側方切開で行い，その後，仰臥位で前方L字型切開を追加し，腫瘍を含めた第1，2，3肋骨切除術を施行した．術後病理検査でも線維性骨異形成の診断で，悪性転化は認めなかった．肋骨原発線維性骨異形成は巨大化することがあり，また上位肋骨発生の症例では切除に難渋することもある．通常の肺尖部肺癌とは異なり骨性胸郭外にも腫瘍が大きく進展するため，術中に鎖骨下腔の視野の展開が困難となることが予想される．このため，前方L字型切開を併用するアプローチを用いる場合には注意を要する．一方，悪性転化や胸郭出口症候群の併発も報告されているため，積極的に手術を行うべきである． |
| Author | 照屋 孝夫 稲福 斉 古堅 智則 古川 浩二郎 當山 昌大 |
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| References | 19. Vasiliadis HS, Arnaoutoglou C, Plakoutsis S, Doukas M, Batistatou A, Xenakis TA. Low-grade central osteosarcoma of distal femur, resembling fibrous dysplasia. World J Orthop 2013; 4: 327-32. 20. Chen Y, Deng K, Zhao C, Xiao W, Tang Z. Resection of the entire first rib for giant osteochondroma by trans manubrial approach: a case report and review of the literature. J Cardiothorac Surg 2024; 19: 359. 14. Hiremagalur SR, Whitaker JH, Kumari NA, Roy TM. Fibrous dysplasia of the rib: an unusual cause of chest pain. Tenn Med 1997; 90: 406-7. 17. Furukawa M, Soh J, Toyooka S, Ozaki T, Miyoshi S. Resection of the entire first rib for fibrous dysplasia using a combined posterior-transmanubrial approach. Gen Thorac Cardiovasc Surg 2012; 60: 584-6. 6. Rehemutula A, Zhang LI, Yu C, Chen L, Gu Y. Thoracoscopy-assisted first rib resection for the treatment of thoracic outlet syndrome caused by fibrous dysplasia: A report of two cases. Exp Ther Med 2015; 9: 2241-4. 3. Weinstein LS, Shenker A, Gejman PV, Merino MJ, Friedman E, Spiegel AM. Activating mutations of the stimulatory G protein in the McCune-Albright syndrome. N Engl J Med 1991; 325: 1688-95. 11. Karanjia ND, Sayer RE. Thoracic outlet syndrome due to monostotic fibrous dysplasia of the first rib. J R Coll Surg Edinb 1990; 35: 111. 2. 内橋和芳. 線維性骨異形成. In: 小田義直, 吉田朗彦編. 腫瘍病理鑑別診断アトラス刊行委員会監修. 腫瘍病理鑑別診断アトラス 骨腫瘍. 第2版. 東京: 文光堂; 2021: 135-9. 8. Stanton RP, Ippolito E, Springfield D, Lindaman L, Wientroub S, Leet A. The surgical management of fibrous dysplasia of bone. Orphanet J Rare Dis 2012; 7: S1. 5. Yamagishi Y, Okamoto M, Yoshimura Y, Kito M, Aoki K, Takahashi J. Continued growth of locally aggressive fibrous dysplasia of 22 years duration after reaching adulthood: a case report. J Surg Case Rep 2020; 2020: rjz406. 18. Hakki U, Reha CM, Mehmet A, Saadet A. Monostotic Giant Fibrous Dysplasia Excised by Two Different Minimal Incisions (Tunnel Method). Indian J Surg 2021; 83: 1542-6. 13. Thomas de Montpréville V, Dulmet E, Ponlot R, Dartevelle P. Giant bilateral fibrous dysplasia of first ribs: compression of mediastinum and thoracic outlet. Eur Respir J 1995; 8: 1028-9. 7. Ruggieri P, Sim FH, Bond JR, Unni KK. Malignancies in Fibrous Dysplasia. Cancer 1994; 73: 1411-24. 10. Hankin FM, Braunstein EM, Orringer MB. Timely evaluation of shoulder pain in a teenager. Am Fam Physician 1986; 33: 177-80. 12. Melliere D, Ben Yahia NE, Etienne G, Becquemin JP, de Labareyre H. Thoracic outlet syndrome caused by tumor of the first rib. J Vasc Surg 1991; 14: 235-40. 16. Kemp CD, Rushing GD, Rodic N, McCarthy E, Yang SC. Thoracic Outlet Syndrome Caused by Fibrous Dysplasia of the First Rib. Ann Thorac Surg 2012; 93: 994-6. 9. Payne-James JJ, Walesby RK. Symptomatic fibrous dysplasia of the right first rib excised via a posterolateral thoracotomy. Thorax 1986; 41: 575-6. 1. Siegal GP, Bloem JL, Cates JMM. Fibrous dysplasia. In: WHO Classification of Tumours Editorial Board, editors.WHO Classification of Tumours, Soft tissue and bone tumours. 5th ed. Lyon: IARC Press; 2020: 472-4. 4. Belaval GS, Schneider RW. Fibrous Dysplasia of bone. Cleve Clin Q 1954; 21: 158-68. 15. Silins I, Simanovica I, Rone I. Resection of the first rib for fibrous dysplasia by transmanubrial approach. Acta Chir Latv 2010; 10: 115-7. |
| References_xml | – reference: 12. Melliere D, Ben Yahia NE, Etienne G, Becquemin JP, de Labareyre H. Thoracic outlet syndrome caused by tumor of the first rib. J Vasc Surg 1991; 14: 235-40. – reference: 2. 内橋和芳. 線維性骨異形成. In: 小田義直, 吉田朗彦編. 腫瘍病理鑑別診断アトラス刊行委員会監修. 腫瘍病理鑑別診断アトラス 骨腫瘍. 第2版. 東京: 文光堂; 2021: 135-9. – reference: 6. Rehemutula A, Zhang LI, Yu C, Chen L, Gu Y. Thoracoscopy-assisted first rib resection for the treatment of thoracic outlet syndrome caused by fibrous dysplasia: A report of two cases. Exp Ther Med 2015; 9: 2241-4. – reference: 18. Hakki U, Reha CM, Mehmet A, Saadet A. Monostotic Giant Fibrous Dysplasia Excised by Two Different Minimal Incisions (Tunnel Method). Indian J Surg 2021; 83: 1542-6. – reference: 11. Karanjia ND, Sayer RE. Thoracic outlet syndrome due to monostotic fibrous dysplasia of the first rib. J R Coll Surg Edinb 1990; 35: 111. – reference: 14. Hiremagalur SR, Whitaker JH, Kumari NA, Roy TM. Fibrous dysplasia of the rib: an unusual cause of chest pain. Tenn Med 1997; 90: 406-7. – reference: 15. Silins I, Simanovica I, Rone I. Resection of the first rib for fibrous dysplasia by transmanubrial approach. Acta Chir Latv 2010; 10: 115-7. – reference: 5. Yamagishi Y, Okamoto M, Yoshimura Y, Kito M, Aoki K, Takahashi J. Continued growth of locally aggressive fibrous dysplasia of 22 years duration after reaching adulthood: a case report. J Surg Case Rep 2020; 2020: rjz406. – reference: 19. Vasiliadis HS, Arnaoutoglou C, Plakoutsis S, Doukas M, Batistatou A, Xenakis TA. Low-grade central osteosarcoma of distal femur, resembling fibrous dysplasia. World J Orthop 2013; 4: 327-32. – reference: 1. Siegal GP, Bloem JL, Cates JMM. Fibrous dysplasia. In: WHO Classification of Tumours Editorial Board, editors.WHO Classification of Tumours, Soft tissue and bone tumours. 5th ed. Lyon: IARC Press; 2020: 472-4. – reference: 7. Ruggieri P, Sim FH, Bond JR, Unni KK. Malignancies in Fibrous Dysplasia. Cancer 1994; 73: 1411-24. – reference: 9. Payne-James JJ, Walesby RK. Symptomatic fibrous dysplasia of the right first rib excised via a posterolateral thoracotomy. Thorax 1986; 41: 575-6. – reference: 17. Furukawa M, Soh J, Toyooka S, Ozaki T, Miyoshi S. Resection of the entire first rib for fibrous dysplasia using a combined posterior-transmanubrial approach. Gen Thorac Cardiovasc Surg 2012; 60: 584-6. – reference: 8. Stanton RP, Ippolito E, Springfield D, Lindaman L, Wientroub S, Leet A. The surgical management of fibrous dysplasia of bone. Orphanet J Rare Dis 2012; 7: S1. – reference: 3. Weinstein LS, Shenker A, Gejman PV, Merino MJ, Friedman E, Spiegel AM. Activating mutations of the stimulatory G protein in the McCune-Albright syndrome. N Engl J Med 1991; 325: 1688-95. – reference: 4. Belaval GS, Schneider RW. Fibrous Dysplasia of bone. Cleve Clin Q 1954; 21: 158-68. – reference: 10. Hankin FM, Braunstein EM, Orringer MB. Timely evaluation of shoulder pain in a teenager. Am Fam Physician 1986; 33: 177-80. – reference: 16. Kemp CD, Rushing GD, Rodic N, McCarthy E, Yang SC. Thoracic Outlet Syndrome Caused by Fibrous Dysplasia of the First Rib. Ann Thorac Surg 2012; 93: 994-6. – reference: 13. Thomas de Montpréville V, Dulmet E, Ponlot R, Dartevelle P. Giant bilateral fibrous dysplasia of first ribs: compression of mediastinum and thoracic outlet. Eur Respir J 1995; 8: 1028-9. – reference: 20. Chen Y, Deng K, Zhao C, Xiao W, Tang Z. Resection of the entire first rib for giant osteochondroma by trans manubrial approach: a case report and review of the literature. J Cardiothorac Surg 2024; 19: 359. |
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| Snippet | 58歳，男性．左前胸部の硬結を主訴に受診した．胸部CTで左第2肋骨より発生し肺尖部を占拠する径12×9 cmの腫瘤を認め，PET-CTで同部位にFDG異常集積を伴っていた．CTガイド... |
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| SubjectTerms | 前方L字状切開 後側方切開 線維性骨異形成 |
| Title | アプローチに工夫を要した左肺尖部巨大肋骨原発線維性骨異形成の1例 |
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