子宮頸部腺癌術後18年目に診断された多発肺転移の1例
症例は76歳女性，58歳時に子宮頸部腺癌に対し，前医にて広汎子宮全摘術と両側付属器摘出術および骨盤内リンパ節郭清を受けた．術後6年半無再発で前医を終診となった．術後18年目に結核検診を受けた際に異常陰影を指摘され，精査目的で当院呼吸器内科を紹介受診した．CTで両側多発肺結節を認め，気管支鏡下肺生検を行うも診断は得られず生検目的に当科紹介となった．胸腔鏡下右肺部分切除術を行い，病理検査では当初，HE染色で肺腺癌の診断となった．一方で，免疫染色ではTTF-1陰性，ER陰性，PgR陰性，p16一部陽性であった．故に，前医病理組織標本と比較し，子宮頸部腺癌肺転移と診断した．現在，当院産婦人科で化学療法...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 38; no. 2; pp. 93 - 98 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本呼吸器外科学会
15.03.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.38.93 |
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| Abstract | 症例は76歳女性，58歳時に子宮頸部腺癌に対し，前医にて広汎子宮全摘術と両側付属器摘出術および骨盤内リンパ節郭清を受けた．術後6年半無再発で前医を終診となった．術後18年目に結核検診を受けた際に異常陰影を指摘され，精査目的で当院呼吸器内科を紹介受診した．CTで両側多発肺結節を認め，気管支鏡下肺生検を行うも診断は得られず生検目的に当科紹介となった．胸腔鏡下右肺部分切除術を行い，病理検査では当初，HE染色で肺腺癌の診断となった．一方で，免疫染色ではTTF-1陰性，ER陰性，PgR陰性，p16一部陽性であった．故に，前医病理組織標本と比較し，子宮頸部腺癌肺転移と診断した．現在，当院産婦人科で化学療法を施行している．子宮頸癌が術後10年以上経過した遠隔期に単臓器多発肺転移をきたした報告は極めて稀である． |
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| AbstractList | 症例は76歳女性，58歳時に子宮頸部腺癌に対し，前医にて広汎子宮全摘術と両側付属器摘出術および骨盤内リンパ節郭清を受けた．術後6年半無再発で前医を終診となった．術後18年目に結核検診を受けた際に異常陰影を指摘され，精査目的で当院呼吸器内科を紹介受診した．CTで両側多発肺結節を認め，気管支鏡下肺生検を行うも診断は得られず生検目的に当科紹介となった．胸腔鏡下右肺部分切除術を行い，病理検査では当初，HE染色で肺腺癌の診断となった．一方で，免疫染色ではTTF-1陰性，ER陰性，PgR陰性，p16一部陽性であった．故に，前医病理組織標本と比較し，子宮頸部腺癌肺転移と診断した．現在，当院産婦人科で化学療法を施行している．子宮頸癌が術後10年以上経過した遠隔期に単臓器多発肺転移をきたした報告は極めて稀である． |
| Author | 重光, 希公生 森, 俊輔 北川, 崇 梁, 泰基 |
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| References_xml | – reference: 2. Wakatsuki M, Kato S, Kiyohara H, Ohno T, Karasawa K, Tamaki T, et al. Late Recurrence Over 5 Years After Definitive Radiation Therapy for 1949 Patients With Uterine Cervical Cancer in Long-term Follow-up Study. Int J Radiat Oncol Biol Phys 2015; 93: E255-6. – reference: 20. McNichols DW, Segura JW, DeWeerd JH. Renal Cell Carcinoma: Long-Term Survival and Late Recurrence. J Urol 1981; 126: 17-23. – reference: 19. Banys-Paluchowski M, Reinhardt F, Fehm T. Disseminated Tumor Cells and Dormancy in Breast Cancer Progression. Adv Exp Med Biol 2020; 1220: 35-43. – reference: 12. Obata T, Nakamura M, Mizumoto Y, Matsumoto T, Takakura M, Fujiwara H. Synchronous endometrioid adenocarcinomas in the uterine cervix and corpus. J Obstet Gynaecol Res 2016; 42: 1390-4. – reference: 16. 小山倫太郎, 花桐武志, 西澤夏將, 芦刈周平, 西中秀和, 山崎 徹. 乳癌術後15年以上を経て原発性肺癌と鑑別を要した乳癌肺転移の3切除例. 産業医大誌 2021; 43: 271-6. – reference: 18. Ogasawara N, Ohkura Y, Ueno M, Haruta S, Nakayama A, Fujii T, et al. Late recurrence of gastric carcinoma 15 years after surgery. Clin J Gastroenterol 2020; 13: 746-53. – reference: 23. Aguirre-Ghiso JA. Models, mechanisms and clinical evidence for cancer dormancy. Nat Rev Cancer 2007; 7: 834-46. – reference: 22. Eyles J, Puaux AL, Wang X, Toh B, Prakash C, Hong M, et al. Tumor cells disseminate early, but immunosurveillance limits metastatic outgrowth, in a mouse model of melanoma. J Clin Invest 2010; 120: 2030-9. – reference: 9. 日本産科婦人科学会, 日本病理学会編. 子宮頸癌取扱い規約 病理編. 第5版. 東京: 金原出版; 2022: 44-5. – reference: 13. van Boerdonk RA, Daniels JM, Bloemena E, Krijgsman O, Steenbergen RD, Brakenhoff RH, et al. High-risk human papillomavirus-positive lung cancer: molecular evidence for a pattern of pulmonary metastasis. J Thorac Oncol 2013; 8: 711-8. – reference: 10. Chen R, Qin P, Luo Q, Yang W, Tan X, Cai T, et al. ER-positive endocervical adenocarcinoma mimicking endometrioid adenocarcinoma in morphology and immunohistochemical profile: A case report of application of HPV RNAscope detection. Medicine (Baltimore) 2021; 100: e24927. – reference: 21. Giancotti FG. Mechanisms Governing Metastatic Dormancy and Reactivation. Cell 2013; 155: 750-64. – reference: 11. Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, et al. International Endocervical Adenocarcinoma Criteria and Classification (IECC): A New Pathogenetic Classification for Invasive Adenocarcinomas of the Endocervix. Am J Surg Pathol 2018; 42: 214-26. – reference: 24. Abu-Rustum NR, Yashar CM, Bean S, Bradley K, Campos SM, Chon HS, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN GuidelinesⓇ) 子宮頸癌 2019年 第4版［Internet］2019; 日本婦人科腫瘍学会 監訳. 医療イノベーション推進センター 作成［Updated: 2019 Mar. 29 Cited: 2023 Jun. 20］Available from: https://www2.tri-kobe.org/nccn/guideline/gynecological/japanese/cervical.pdf. – reference: 8. 廣瀬 宗, 上田 和, 駒崎裕美, 鳴井千景, 高橋一彰, 永田知映, 他. 免疫組織学的検査を試みた子宮頸部類内膜腺癌の2例. 関東連産婦会誌 2014; 51: 583-91. – reference: 17. 團野克樹, 東山聖彦, 檜垣直純, 高見康二, 大宮英泰, 児玉 憲. 急速に出現増大した腎癌術後晩期肺靱帯転移の1例. 日臨外会誌 2003; 64: 2020-4. – reference: 4. Elit L, Fyles AW, Devries MC, Oliver TK, Fung-Kee-Fung M; Gynecology Cancer Disease Site Group. Follow-up for women after treatment for cervical cancer: a systematic review. Gynecol Oncol 2009; 114: 528-35. – reference: 1. Goto T, Kino N, Shirai T, Fujimura M, Takahashi M, Shiromizu K. Late recurrence of invasive cervical cancer: twenty years' experience in a single cancer institute. J Obstet Gynaecol Res 2005; 31: 514-9. – reference: 7. Burks RT, Schwartz AM, Wheeler JE, Antonioli D. Late recurrence of clear-cell adenocarcinoma of the cervix: case report. Obstet Gynecol 1990; 76: 525-7. – reference: 15. 久高 学. 乳癌術後23年目に肺転移をきたした高齢者晩期再発の1例. 外科 2022; 84: 1294-9. – reference: 3. Van Herik M, Decker DG, Lee RA, Symmonds RE. Late recurrence in carcinoma of the cervix. Am J Obstet Gynecol 1970; 108: 1183-6. – reference: 5. Shimada M, Nishimura R, Nogawa T, Hatae M, Takehara K, Yamada H, et al. Comparison of the outcome between cervical adenocarcinoma and squamous cell carcinoma patients with adjuvant radiotherapy following radical surgery: SGSG/TGCU Intergroup Surveillance. Mol Clin Oncol 2013; 1: 780-4. – reference: 6. 日本婦人科腫瘍学会編. 子宮頸癌治療ガイドライン2022年版. 第4版. 東京: 金原出版; 2022: 176. – reference: 14. Yamamoto K, Yoshikawa H, Shiromizu K, Saito T, Kuzuya K, Tsunematsu R, et al. Pulmonary metastasectomy for uterine cervical cancer: a multivariate analysis. Ann Thorac Surg 2004; 77: 1179-82. |
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| Snippet | 症例は76歳女性，58歳時に子宮頸部腺癌に対し，前医にて広汎子宮全摘術と両側付属器摘出術および骨盤内リンパ節郭清を受けた．術後6年半無再発で前医を終診となった．術... |
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| Title | 子宮頸部腺癌術後18年目に診断された多発肺転移の1例 |
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