EUS-B-FNAが上皮型悪性胸膜中皮腫の診断に有用であった1例

背景．超音波気管支鏡下経食道的針生検（endoscopic ultrasound with bronchoscope-guided fine-needle aspiration：EUS-B-FNA）は，食道に接する胸腔内および縦隔病変の診断に有用であることが報告されている．症例．70歳男性．発熱と咳嗽を訴え，胸部CTで右胸腔内に最大径50 mm大の多発する胸膜腫瘤影を指摘された．FDG-PETでは腫瘤にFDG異常集積を認め，肺癌胸膜播種や悪性胸膜中皮腫などが疑われた．腫瘤が気道に接しておらず，食道に接していたため，通常の気管支鏡では診断が困難と考え，超音波気管支鏡を用いて経食道的に腫瘤を生検し...

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Published inThe Journal of the Japan Society for Respiratory Endoscopy Vol. 38; no. 4; pp. 278 - 284
Main Authors 豊田, 行英, 高橋, 好行, 飯田, 智彦, 藤原, 大樹, 田村, 創, 柴, 光年
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本呼吸器内視鏡学会 2016
日本呼吸器内視鏡学会
The Japan Society for Respiratory Endoscopy
Subjects
Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration
Malignant pleural mesothelioma
悪性胸膜中皮腫
超音波気管支鏡下経食道的針生検（EUS-B-FNA）
Online AccessGet full text
ISSN0287-2137
2186-0149
DOI10.18907/jjsre.38.4_278

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Abstract 背景．超音波気管支鏡下経食道的針生検（endoscopic ultrasound with bronchoscope-guided fine-needle aspiration：EUS-B-FNA）は，食道に接する胸腔内および縦隔病変の診断に有用であることが報告されている．症例．70歳男性．発熱と咳嗽を訴え，胸部CTで右胸腔内に最大径50 mm大の多発する胸膜腫瘤影を指摘された．FDG-PETでは腫瘤にFDG異常集積を認め，肺癌胸膜播種や悪性胸膜中皮腫などが疑われた．腫瘤が気道に接しておらず，食道に接していたため，通常の気管支鏡では診断が困難と考え，超音波気管支鏡を用いて経食道的に腫瘤を生検した．組織学的には好酸性の胞体を有する上皮性異型細胞集塊を認め，免疫組織学的にcalretinin，WT-1陽性，CEA，Ber-EP4陰性であった．胸腔鏡下生検で脂肪層を含めた壁側胸膜全層検体による腫瘍の再評価を行い，上皮型悪性胸膜中皮腫と診断した．結論．EUS-B-FNAにて上皮型悪性胸膜中皮腫の病理診断に十分な腫瘍組織の採取が可能であった．食道に近接する上皮型悪性胸膜中皮腫の診断にEUS-B-FNAは有用である．
AbstractList 「要約」-「背景」. 超音波気管支鏡下経食道的針生検(endoscopic ultrasound with bronchoscope-guided fine-needle aspiration:EUS-B-FNA)は, 食道に接する胸腔内および縦隔病変の診断に有用であることが報告されている. 「症例」. 70歳男性. 発熱と咳嗽を訴え, 胸部CTで右胸腔内に最大径50mm大の多発する胸膜腫瘤影を指摘された. FDG-PETでは腫瘤にFDG異常集積を認め, 肺癌胸膜播種や悪性胸膜中皮腫などが疑われた. 腫瘤が気道に接しておらず, 食道に接していたため, 通常の気管支鏡では診断が困難と考え, 超音波気管支鏡を用いて経食道的に腫瘤を生検した. 組織学的には好酸性の胞体を有する上皮性異型細胞集塊を認め, 免疫組織学的にcalretinin, WT-1陽性, CEA, Ber-EP4陰性であった. 胸腔鏡下生検で脂肪層を含めた壁側胸膜全層検体による腫瘍の再評価を行い, 上皮型悪性胸膜中皮腫と診断した. 「結論」. EUS-B-FNAにて上皮型悪性胸膜中皮腫の病理診断に十分な腫瘍組織の採取が可能であった. 食道に近接する上皮型悪性胸膜中皮腫の診断にEUS-B-FNAは有用である.
背景．超音波気管支鏡下経食道的針生検（endoscopic ultrasound with bronchoscope-guided fine-needle aspiration：EUS-B-FNA）は，食道に接する胸腔内および縦隔病変の診断に有用であることが報告されている．症例．70歳男性．発熱と咳嗽を訴え，胸部CTで右胸腔内に最大径50 mm大の多発する胸膜腫瘤影を指摘された．FDG-PETでは腫瘤にFDG異常集積を認め，肺癌胸膜播種や悪性胸膜中皮腫などが疑われた．腫瘤が気道に接しておらず，食道に接していたため，通常の気管支鏡では診断が困難と考え，超音波気管支鏡を用いて経食道的に腫瘤を生検した．組織学的には好酸性の胞体を有する上皮性異型細胞集塊を認め，免疫組織学的にcalretinin，WT-1陽性，CEA，Ber-EP4陰性であった．胸腔鏡下生検で脂肪層を含めた壁側胸膜全層検体による腫瘍の再評価を行い，上皮型悪性胸膜中皮腫と診断した．結論．EUS-B-FNAにて上皮型悪性胸膜中皮腫の病理診断に十分な腫瘍組織の採取が可能であった．食道に近接する上皮型悪性胸膜中皮腫の診断にEUS-B-FNAは有用である．
Background. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is useful for diagnosis of pleural and mediastinal neoplastic lesions adjacent to the esophagus. Case. A 70-year-old man was referred to our hospital for evaluation of fever and cough. Chest CT scan showed multiple pleural tumors (maximum size, 50 mm) in the right thoracic wall. FDG-PET revealed abnormally increased FDG uptake in the tumors. A lung cancer with dissemination or malignant pleural mesothelioma was suspected. The tumors were not adjacent to the airways but were adjacent to the esophagus, so we performed a biopsy through the esophagus using an endoscopic ultrasound with a bronchoscope (EBUS) to diagnose them. Histologic examination showed eosinophilic epithelial atypical cell clusters, and immunohistochemical staining of epithelial atypical cells was positive for calretinin and WT-1, and negative for CEA and Ber-EP4. We performed pleuroscopic pleural biopsy to obtain a specimen that contained all layers of the pleural tumor with fat. The final diagnosis was epithelioid malignant pleural mesothelioma. Conclusion. We could obtain a good quality and adequate specimen for diagnosing epithelioid malignant pleural mesothelioma. EUS-B-FNA is useful for the diagnosis of epithelioid malignant pleural mesothelioma adjacent to the esophagus. 背景．超音波気管支鏡下経食道的針生検（endoscopic ultrasound with bronchoscope-guided fine-needle aspiration：EUS-B-FNA）は，食道に接する胸腔内および縦隔病変の診断に有用であることが報告されている．症例．70歳男性．発熱と咳嗽を訴え，胸部CTで右胸腔内に最大径50 mm大の多発する胸膜腫瘤影を指摘された．FDG-PETでは腫瘤にFDG異常集積を認め，肺癌胸膜播種や悪性胸膜中皮腫などが疑われた．腫瘤が気道に接しておらず，食道に接していたため，通常の気管支鏡では診断が困難と考え，超音波気管支鏡を用いて経食道的に腫瘤を生検した．組織学的には好酸性の胞体を有する上皮性異型細胞集塊を認め，免疫組織学的にcalretinin，WT-1陽性，CEA，Ber-EP4陰性であった．胸腔鏡下生検で脂肪層を含めた壁側胸膜全層検体による腫瘍の再評価を行い，上皮型悪性胸膜中皮腫と診断した．結論．EUS-B-FNAにて上皮型悪性胸膜中皮腫の病理診断に十分な腫瘍組織の採取が可能であった．食道に近接する上皮型悪性胸膜中皮腫の診断にEUS-B-FNAは有用である．
Author 飯田, 智彦
柴, 光年
豊田, 行英
田村, 創
藤原, 大樹
高橋, 好行
Author_FL Iida Tomohiko
Shiba Mitsutoshi
Tamura Hajime
Toyoda Takahide
Takahashi Yoshiyuki
Fujiwara Taiki
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DocumentTitleAlternate A Case of Epithelioid Malignant Pleural Mesothelioma Diagnosed with Endoscopic Ultrasound with Bronchoscope-guided Fine-needle Aspiration
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References 2. Agarwal PP, Seely JM, Matzinger FR, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology. 2006;241:589-594.
13. Rice DC, Steliga MA, Stewart J, et al. Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma. Ann Thorac Surg. 2009;88:862-869.
3. Scherpereel A, Astoul P, Baas P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35:479-495.
12. Tournoy KG, Burgers SA, Annema JT, et al. Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma. Clin Cancer Res. 2008;14:6259-6263.
11. 猿渡功一, 今村文哉, 津守香里, ほか. 経食道的超音波内視鏡下穿刺吸引術によって診断した悪性胸膜中皮腫の1例. 日呼吸誌. 2014;3:65-69.
4. Hamamoto J, Notsute D, Tokunaga K, et al. Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma. Intern Med. 2010;49:423-426.
7. Yokoyama T, Hirata A, Nishizawa T, et al. A case of pleural mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration. J Jpn Soc Respir Endoscopy. 2015;37:285-289.
15. Hammar SP. Macroscopic, histologic, histochemical, immunohistochemical, and ultrastructural features of mesothelioma. Ultrastruct Pathol. 2006;30:3-17.
8. Kahi CJ, Dewitt JM, Lykens M, et al. Diagnosis of a malignant mesothelioma by EUS-guided FNA of a mediastinal lymph node. Gastrointest Endosc. 2004;60:859-861.
1. 廣島健三, 石川雄一, 岡田守人, ほか. 悪性胸膜中皮腫病理診断の手引き. 第1.0版, 日本肺癌学会; 2013.
6. Kang B, Kim MA, Lee BY, et al. Malignant pleural mesothelioma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Tuberc Respir Dis. 2013;74:74-78.
10. Al-Bawardy B, Gorospe EC, Leggett C. Malignant mesothelioma presenting as dysphagia diagnosed by endoscopic ultrasound. Ann Gastroenterol. 2014;27:409.
9. Bakdounes K, Jhala N, Jhala D. Diagnostic usefulness and challenges in the diagnosis of mesothelioma by endoscopic ultrasound guided fine needle aspiration. Diagn Cytopathol. 2008;36:503-507.
5. 南 大輔, 瀧川奈義夫, 堀田勝幸, ほか. 呼吸器・縦隔疾患診断における超音波気管支鏡ガイド下針生検の有用性. 日呼吸誌. 2012;1:102-106.
14. Araya T, Demura Y, Kasahara K, et al. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. J Bronchology Interv Pulmonol. 2013;20:121-126.
References_xml – reference: 1. 廣島健三, 石川雄一, 岡田守人, ほか. 悪性胸膜中皮腫病理診断の手引き. 第1.0版, 日本肺癌学会; 2013.
– reference: 15. Hammar SP. Macroscopic, histologic, histochemical, immunohistochemical, and ultrastructural features of mesothelioma. Ultrastruct Pathol. 2006;30:3-17.
– reference: 12. Tournoy KG, Burgers SA, Annema JT, et al. Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma. Clin Cancer Res. 2008;14:6259-6263.
– reference: 3. Scherpereel A, Astoul P, Baas P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35:479-495.
– reference: 14. Araya T, Demura Y, Kasahara K, et al. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. J Bronchology Interv Pulmonol. 2013;20:121-126.
– reference: 4. Hamamoto J, Notsute D, Tokunaga K, et al. Diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in a case with malignant pleural mesothelioma. Intern Med. 2010;49:423-426.
– reference: 6. Kang B, Kim MA, Lee BY, et al. Malignant pleural mesothelioma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Tuberc Respir Dis. 2013;74:74-78.
– reference: 10. Al-Bawardy B, Gorospe EC, Leggett C. Malignant mesothelioma presenting as dysphagia diagnosed by endoscopic ultrasound. Ann Gastroenterol. 2014;27:409.
– reference: 11. 猿渡功一, 今村文哉, 津守香里, ほか. 経食道的超音波内視鏡下穿刺吸引術によって診断した悪性胸膜中皮腫の1例. 日呼吸誌. 2014;3:65-69.
– reference: 5. 南 大輔, 瀧川奈義夫, 堀田勝幸, ほか. 呼吸器・縦隔疾患診断における超音波気管支鏡ガイド下針生検の有用性. 日呼吸誌. 2012;1:102-106.
– reference: 2. Agarwal PP, Seely JM, Matzinger FR, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology. 2006;241:589-594.
– reference: 9. Bakdounes K, Jhala N, Jhala D. Diagnostic usefulness and challenges in the diagnosis of mesothelioma by endoscopic ultrasound guided fine needle aspiration. Diagn Cytopathol. 2008;36:503-507.
– reference: 8. Kahi CJ, Dewitt JM, Lykens M, et al. Diagnosis of a malignant mesothelioma by EUS-guided FNA of a mediastinal lymph node. Gastrointest Endosc. 2004;60:859-861.
– reference: 7. Yokoyama T, Hirata A, Nishizawa T, et al. A case of pleural mesothelioma diagnosed on endobronchial ultrasound-guided transbronchial needle aspiration. J Jpn Soc Respir Endoscopy. 2015;37:285-289.
– reference: 13. Rice DC, Steliga MA, Stewart J, et al. Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma. Ann Thorac Surg. 2009;88:862-869.
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Snippet 背景．超音波気管支鏡下経食道的針生検（endoscopic ultrasound with bronchoscope-guided fine-needle aspiration：EUS-B-FNA）は，食道に接する胸腔内および縦隔病変の...
「要約」-「背景」. 超音波気管支鏡下経食道的針生検(endoscopic ultrasound with bronchoscope-guided fine-needle aspiration:EUS-B-FNA)は, 食道に接する胸腔内および縦隔...
Background. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is useful for diagnosis of pleural and mediastinal neoplastic...
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medicalonline
jstage
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StartPage 278
SubjectTerms Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration
Malignant pleural mesothelioma
悪性胸膜中皮腫
超音波気管支鏡下経食道的針生検（EUS-B-FNA）
Title EUS-B-FNAが上皮型悪性胸膜中皮腫の診断に有用であった1例
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