Takanori Kanematsu

Multiple pulmonary nodular lesions were noted on a chest X-ray film of a 56-year-old man. Partial resection of the left lung via thoracoscopy was performed, yielding a pathological diagnosis of leiomyosarcoma. Positron emission tomography/computed tomography (PET/CT) and other examinations revealed that the lesions originated in the lung. Chemotherapy with adriamycin and ifosfamide was performed but was ineffective. It is reported that leiomyosarcoma with multiple pulmonary nodules often derives from a uterine primary lesion. Primary pulmonary leiomyosarcoma with multiple nodular lesions is rare, but it should be considered in the differential diagnosis in cases with multiple lung nodules.

A 67-year-old woman who complained of pain and sensory disturbance in the right upper extremity was admitted. Her chest CT showed a mass lesion in the upper lobe of the right lung, indicating invasion to the chest wall. CT-guided tumor biopsy resulted in a diagnosis of squamous cell carcinoma, and FDG-PET scan suggested metastasis to the right supraclavicular lymph node. We diagnosed squamous cell lung cancer (T3N3M0 : stage IIIB) and started chemotherapy using carboplatin and vinorelbine combined with thoracic radiotherapy. At the end of 6th cycles of chemotherapy, exertional dyspnea and palpitations appeared, and she was readmitted. Repeated transthoracic echocardiography showed a deterioration of the thickening of the right ventricular wall. Magnetic resonance imaging and Ga-scintigraphy suggested a neoplastic lesion in the myocardium. Eventually, we diagnosed it as myocardial metastasis from non-small cell lung cancer. Shortly after the beginning of palliative radiotherapy to the myocardial lesion, repeated episodes of ventricular tachycardia emerged. We stopped radiotherapy and managed to control the ventricular tachycardia by initiating amiodarone. Though we administered erlotinib as a second line chemotherapy, the primary tumor and pericardial effusion progressed and pleural effusion appeared, so we discontinued erlotinib. Pericardiocentesis was carried out to improve her symptoms and cytological examination of effusion revealed class IV. Her performance status dropped off and we decided to continue best supportive care. Myocardial metastasis of lung cancer is rarely a clinical problem, but it might have a decisive influence on the patient's prognosis due to serious arrhythmia or some other complications. Therefore, there is a need to consider cardiac involvement in the course of lung cancer.

背景. 口蓋扁桃の転移性腫瘍は非常に稀である. 我々は口蓋扁桃に転移を来した非小細胞肺癌の2例を経験した.この2例を含め, 我々が集計し得た本邦の既報告の28例と合わせ, 文献的考察を加えて報告する. 症例. 症例1は52歳男性.主訴は呼吸困難. 近医にて胸部異常陰影を指摘され当院紹介. 精査にて左上葉原発の扁平上皮癌T4N2MO, stage IIIBと診断した. 原発巣への放射線療法施行中に咽頭痛が出現し, 左口蓋扁桃に厚い白苔に覆われた転移性腫瘍が認められた. 放射線療法により扁桃転移巣は著明に縮小したが, 原発巣の増大により扁桃転移診断後9ヶ月で死亡した. 症例2は52歳男性. 主訴は咽頭痛. 近医にて胸部異常陰影, 両側扁桃腫瘤を指摘され当院紹介. 精査にて右上葉原発の大細胞癌T3NOM1, stage IVと診断した. 入院時, 両側口蓋扁桃に白苔と潰瘍形成を伴う凹凸不整な転移性腫瘍が認められた. 全身化学療法により扁桃転移巣は消失した. 現在扁桃転移診断後9ヶ月であるが, 担癌生存中である. 結論. 非常に稀な口蓋扁桃転移を来した非小細胞肺癌の2例を報告した.