Journal Article 肺類上皮血管内皮腫の2例
Two Cases of Pulmonary Epithelioid Hemangioendothelioma

石井, 奏  ,  松本, 勲  ,  高田, 宗尚  ,  田村, 昌也  ,  斉藤, 大輔  ,  竹村, 博文

56 ( 7 )  , pp.1028 - 1033 , 2017-01-19 , 日本肺癌学会 = The Japan Lung Cancer Society
背景.類上皮血管内皮腫は血管内皮由来の非上皮性腫瘍で,肺や肝などに発生する極めて稀な腫瘍である.術前診断が困難であった肺類上皮血管内皮腫の2例を経験したので,報告する.症例1.67歳,男性.検診の胸部X線写真にて胸部異常陰影を指摘された.胸部CT検査では左S1+2を中心にS6にまたがる1.5 cm大の結節を認めた.左肺癌を疑い,左肺上葉切除およびS6部分切除を施行した.術中迅速診断では腺癌で,ND2a-1を施行した.術後病理診断は,CD31,CD34陽性であり,類上皮血管内皮腫と診断.術後12年で再発なく経過観察中である.症例2.64歳,女性.咳嗽を認め前医受診.胸部X線写真および胸部CTにて多発肺結節を認め,当科に紹介された.腹部MRIでは肝臓にも多発結節を認めた.悪性疾患の原発巣と考えられる病変は同定し得ず,診断目的に右肺部分切除を行った.病理診断で,CD31,CD34,factor VIII陽性であり,類上皮血管内皮腫と診断.術後1年半で,経過観察中であるが増悪はない.結論.肺類上皮血管内皮腫の2例を経験した.術前診断が困難で,確定診断には外科的生検,免疫組織学的診断が有用である.Background. Epithelioid hemangioendothelioma is an extremely rare non-epithelial tumor originating from the vascular endothelial cells that arises in organs such as the lungs and liver. We report two cases of epithelioid hemangioendothelioma in which it was difficult to make a preoperative diagnosis. Case 1. A 67-year-old male patient was found to have an abnormal shadow on a chest X-ray during a health-checkup, was referred to our department. Chest computed tomography (CT) showed a nodule of 1.5 cm in diameter at segment 1+2 of the left lung. The patient underwent left upper lobectomy and partial resection of segment 6 of the left lung with ND2a-1 lymph node dissection for suspected left lung cancer. The frozen section diagnosis was papillary adenocarcinoma. Following a postoperative pathological examination, the patient was diagnosed with epithelioid hemangioendothelioma. Case 2. A 64-year-old woman presented with coughing symptoms. A chest X-ray and CT showed multiple nodules, and the patient was referred to our department for diagnostic purposes. Abdominal magnetic resonance imaging (MRI) also showed multiple hepatic nodules. The patient underwent partial resection of the right middle and lower lobe of the lung to allow for the definite diagnosis of the abnormal shadow. Epithelioid hemangioendothelioma was diagnosed based on the pathological findings. Conclusions. We encountered two cases of epithelioid hemangioendothelioma in which it was difficult to make a preoperative diagnosis. A surgical biopsy and immunohistochemistry are useful for making a definitive diagnosis in cases of epithelioid hemangioendothelioma.
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