Iwasaki T, Matsumura A, Yamamoto S, Sueki H, Mori T, Iuchi K
Department of Thoracic Surgery, National Kinki-Chuo Hospital for Chest Diseases, Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Oct;48(10):676-9. doi: 10.1007/BF03218229.
A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules. Chest drainage failed to completely reexpand the lung, necessitating video-assisted thoracic surgery. Thoracoscopy showed pleural thickening in the apical segment without bullae or air leakage, dark-brown pigmentation of the diaphragm, and an unsuspected small nodule about 5 mm in diameter on the diaphragmatic surface of the right lower lobe. Pneumothorax was treated by mechanical abrasion of parietal pleura and upper lobe wedge resection. The lower lobe and nodule were wedge-resected using staplers. The nodule was bronchioloalveolar carcinoma of Noguchi's type B. To improve curability and check for diaphragmatic lesions, right posterolateral thoracotomy was conducted on post-video-assisted thoracic surgery day 28. Aggressive intraoperative lymph node exploration yielded no remarkable histological findings. Nonanatomical lower lobe wedge resection was done and the diaphragm with pinhole-like perforations was partially resected. The resected lung showed no cancerous tissue. Endometrial tissue was histologically confirmed in the resected diaphragm. The patient has remained asymptomatic in 14-month follow-up. This is, to our knowledge, the first lung cancer accompanied by catamenial pneumothorax.
一名45岁的不吸烟女性,反复出现咳嗽和劳力性呼吸困难,因胸部X线检查诊断为右侧气胸入院。胸部计算机断层扫描显示既无肺大疱也无结节。胸腔闭式引流未能使肺完全复张,因此需要进行电视辅助胸腔镜手术。胸腔镜检查显示尖段胸膜增厚,无肺大疱或漏气,膈肌呈深褐色色素沉着,右下叶膈面有一个直径约5mm的意外小结节。气胸通过壁层胸膜机械摩擦和上叶楔形切除术进行治疗。下叶和结节使用吻合器进行楔形切除。该结节为Noguchi B型细支气管肺泡癌。为提高治愈率并检查膈肌病变,在电视辅助胸腔镜手术后第28天进行了右后外侧开胸手术。术中积极进行淋巴结探查未发现明显的组织学异常。进行了非解剖性下叶楔形切除术,并部分切除了有针孔样穿孔的膈肌。切除的肺组织未见癌组织。在切除的膈肌中经组织学证实有子宫内膜组织。在14个月的随访中,患者一直无症状。据我们所知,这是首例伴有月经性气胸的肺癌。