胸腔鏡手術を先行することで完全切除し得た卵黄囊腫瘍の1例
38歳男性．胸痛を契機に胸部異常影を指摘され，当科紹介となった．CT（Computed tomography）にて，上大静脈と左腕頭静脈を圧排する16×13×9 cm大の前縦隔腫瘤を認め，CTガイド下針生検で卵黄囊腫瘍の診断となった．BEP療法（bleomycin，etoposide，and platinum）を施行したが，薬剤性肺障害を併発したため，化学療法を中止し手術の方針となった．右肺浸潤や横隔神経との癒着が疑われたため，胸腔鏡手術を先行した．左側臥位で胸腔鏡手術を施行，右肺上中葉の部分合併切除を行い，横隔神経を腫瘍から剥離温存した．仰臥位に体位変換後，胸骨正中切開で腫瘍を切除した．心膜...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 33; no. 7; pp. 706 - 713 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器外科学会
15.11.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.33.706 |
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| Abstract | 38歳男性．胸痛を契機に胸部異常影を指摘され，当科紹介となった．CT（Computed tomography）にて，上大静脈と左腕頭静脈を圧排する16×13×9 cm大の前縦隔腫瘤を認め，CTガイド下針生検で卵黄囊腫瘍の診断となった．BEP療法（bleomycin，etoposide，and platinum）を施行したが，薬剤性肺障害を併発したため，化学療法を中止し手術の方針となった．右肺浸潤や横隔神経との癒着が疑われたため，胸腔鏡手術を先行した．左側臥位で胸腔鏡手術を施行，右肺上中葉の部分合併切除を行い，横隔神経を腫瘍から剥離温存した．仰臥位に体位変換後，胸骨正中切開で腫瘍を切除した．心膜と左腕頭静脈を合併切除し，外科的完全切除を完遂した．術後に重症合併症は認めなかった．胸腔鏡手術の先行により，良好な視野で肺部分切除と横隔神経の温存ができ，完全切除し得た卵黄囊腫瘍の1例を経験した． |
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| AbstractList | 38歳男性．胸痛を契機に胸部異常影を指摘され，当科紹介となった．CT（Computed tomography）にて，上大静脈と左腕頭静脈を圧排する16×13×9 cm大の前縦隔腫瘤を認め，CTガイド下針生検で卵黄囊腫瘍の診断となった．BEP療法（bleomycin，etoposide，and platinum）を施行したが，薬剤性肺障害を併発したため，化学療法を中止し手術の方針となった．右肺浸潤や横隔神経との癒着が疑われたため，胸腔鏡手術を先行した．左側臥位で胸腔鏡手術を施行，右肺上中葉の部分合併切除を行い，横隔神経を腫瘍から剥離温存した．仰臥位に体位変換後，胸骨正中切開で腫瘍を切除した．心膜と左腕頭静脈を合併切除し，外科的完全切除を完遂した．術後に重症合併症は認めなかった．胸腔鏡手術の先行により，良好な視野で肺部分切除と横隔神経の温存ができ，完全切除し得た卵黄囊腫瘍の1例を経験した． |
| Author | 菅野, 健児 山本, 健嗣 木越, 宏紀 前原, 孝光 根本, 大士 益田, 宗孝 |
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| References | 1. Stang A, Trabert B, Wentzensen N, Cook MB, Rusner C, Oosterhuis JW, et al. Gonadal and extragonadal germ cell tumours in the United States, 1973-2007. Int J Androl 2012; 35: 616-25. 8. Kesler KA, Rieger KM, Hammoud ZT, Kruter LE, Perkins SM, Turrentine MW, et al. A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors. Ann Thorac Surg 2008; 85: 371-8. 2. Trama A, Mallone S, Nicolai N, Necchi A, Schaapveld M, Gietema J, et al. Burden of testicular, paratesticular and extragonadal germ cell tumours in Europe. Eur J Cancer 2012; 48: 159-69. 10. Schneider BP, Kesler KA, Brooks JA, Yiannoutsos C, Einhorn LH. Outcome of patients with residual germ cell or non-germ cell malignancy after resection of primary mediastinal nonseminomatous germ cell cancer. J Clin Oncol 2004; 22: 1195-200. 3. Bokemeyer C, Nichols CR, Droz JP, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retrpperitoneum: results from an international analysis. J Clin Oncol 2002; 20: 1864-73. 9. Nakamura Y, Matsumura A, Katsura H, Sakaguchi M, Ito N, Kitahara N, et al. Cisplatin-based chemotherapy followed by surgery for malignant nonseminomatous germ cell tumor of mediastinum: One institution's experience. Gen Thorac Cardiovasc Surg 2009; 57: 363-8. 4. Walsh GL, Taylor GD, Nesbitt JC, Amato RJ. Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors. Ann Thorac Surg 2000; 69: 337-43. 7. Sarkaria IS, Bains MS, Sood S, Sima CS, Reuter VE, Flores RM, et al. Resection of primary mediastinal non-seminomatous germ cell tumors: a 28-year experience at memorial sloan-kettering cancer center. J Thorac Oncol 2011; 6: 1236-41. 11. 坂井貴志, 青景圭樹, 三好智裕, 松原伸晃, 石井源一郎, 関原圭吾, 他. 縦隔原発非セミノーマ胚細胞腫瘍に対する化学療法後残存腫瘍切除術の治療成績とその予後の検討. 日呼外会誌 2017; 31: 3-7. 6. Liu B, Lin G, Liu J, Liu H, Shang X, Li J. Primary mediastinal yolk sac tumor treated with platinum-based chemotherapy and extended resection: Report of seven cases. Thorac Cancer 2018; 9: 491-4. 5. Kesler KA, Rieger KM, Ganjoo KN, Sharma M, Fineberg NS, Einhorn LH, et al. Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery. J Thorac Cardiovasc Surg 1999; 118: 692-700. |
| References_xml | – reference: 2. Trama A, Mallone S, Nicolai N, Necchi A, Schaapveld M, Gietema J, et al. Burden of testicular, paratesticular and extragonadal germ cell tumours in Europe. Eur J Cancer 2012; 48: 159-69. – reference: 6. Liu B, Lin G, Liu J, Liu H, Shang X, Li J. Primary mediastinal yolk sac tumor treated with platinum-based chemotherapy and extended resection: Report of seven cases. Thorac Cancer 2018; 9: 491-4. – reference: 8. Kesler KA, Rieger KM, Hammoud ZT, Kruter LE, Perkins SM, Turrentine MW, et al. A 25-year single institution experience with surgery for primary mediastinal nonseminomatous germ cell tumors. Ann Thorac Surg 2008; 85: 371-8. – reference: 11. 坂井貴志, 青景圭樹, 三好智裕, 松原伸晃, 石井源一郎, 関原圭吾, 他. 縦隔原発非セミノーマ胚細胞腫瘍に対する化学療法後残存腫瘍切除術の治療成績とその予後の検討. 日呼外会誌 2017; 31: 3-7. – reference: 3. Bokemeyer C, Nichols CR, Droz JP, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retrpperitoneum: results from an international analysis. J Clin Oncol 2002; 20: 1864-73. – reference: 4. Walsh GL, Taylor GD, Nesbitt JC, Amato RJ. Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors. Ann Thorac Surg 2000; 69: 337-43. – reference: 10. Schneider BP, Kesler KA, Brooks JA, Yiannoutsos C, Einhorn LH. Outcome of patients with residual germ cell or non-germ cell malignancy after resection of primary mediastinal nonseminomatous germ cell cancer. J Clin Oncol 2004; 22: 1195-200. – reference: 1. Stang A, Trabert B, Wentzensen N, Cook MB, Rusner C, Oosterhuis JW, et al. Gonadal and extragonadal germ cell tumours in the United States, 1973-2007. Int J Androl 2012; 35: 616-25. – reference: 5. Kesler KA, Rieger KM, Ganjoo KN, Sharma M, Fineberg NS, Einhorn LH, et al. Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery. J Thorac Cardiovasc Surg 1999; 118: 692-700. – reference: 7. Sarkaria IS, Bains MS, Sood S, Sima CS, Reuter VE, Flores RM, et al. Resection of primary mediastinal non-seminomatous germ cell tumors: a 28-year experience at memorial sloan-kettering cancer center. J Thorac Oncol 2011; 6: 1236-41. – reference: 9. Nakamura Y, Matsumura A, Katsura H, Sakaguchi M, Ito N, Kitahara N, et al. Cisplatin-based chemotherapy followed by surgery for malignant nonseminomatous germ cell tumor of mediastinum: One institution's experience. Gen Thorac Cardiovasc Surg 2009; 57: 363-8. |
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| SubjectTerms | BEP 卵黄囊腫瘍 縦隔原発胚細胞性腫瘍 胸腔鏡手術 術前化学療法 |
| Title | 胸腔鏡手術を先行することで完全切除し得た卵黄囊腫瘍の1例 |
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