Adachi Y, Nakamura H, Nitta S
Department of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan.
Kyobu Geka. 2006 Jul;59(7):597-601.
A 78-year-old man with old tuberculosis was pointed out the high CEA (347 ng/ml) and a mass shadow in right side of middle mediastinum. Examination by bronchoscopy showed no abnormal finding, cytological diagnosis of sputum was negative. In computed tomography (CT), there was tumor-like shadow in the right upper lobe and mass shadow in the right side of middle mediastinum, and we suspected of lung cancer. We performed a wedge resection in the right upper lobe with regional lymph node dissection. In the histological diagnosis, there were no malignant finding in the right lung, and mediastinal lymph nodes showed poorly differentiated adenocarcinoma. In immunohistochemistry staining, CEA was positive, surfactant apoprotein and thyroid transcription factor-1 (TTF 1) were negative. Postoperative course was uneventful and 50 Gy radiotherapy were given. CEA was decreased to 2.1 ng/ml 6 months after the operation. This case was highly suspected to be a rare case of T0N2M0 lung cancer.
一名78岁患有陈旧性肺结核的男性，被发现癌胚抗原（CEA）水平升高（347 ng/ml），且中纵隔右侧有一肿块阴影。支气管镜检查未发现异常，痰细胞学诊断为阴性。在计算机断层扫描（CT）中，右上叶有肿瘤样阴影，中纵隔右侧有肿块阴影，我们怀疑是肺癌。我们对右上叶进行了楔形切除术并进行了区域淋巴结清扫。组织学诊断显示右肺无恶性病变，纵隔淋巴结显示低分化腺癌。免疫组化染色中，CEA呈阳性，表面活性蛋白和甲状腺转录因子-1（TTF 1）呈阴性。术后过程顺利，并给予了50 Gy的放疗。术后6个月CEA降至2.1 ng/ml。该病例高度怀疑是罕见的T0N2M0肺癌病例。
