Tsukioka Takuma, Inoue Kiyotoshi, Oka Hiroko, Nishiyama Noritoshi
Department of Thoracic Surgery, Bell land General Hospital, Sakai, Japan.
Kyobu Geka. 2012 Aug;65(9):781-4.
A 76-year-old man with dyspnea and left side chest pain was admitted to our hospital. Chest roentgenogram showed a left side pneumothorax. Chest computed tomography( CT) showed a mass shadow in S3 and a nodular shadow in S10 of left lung. Drainage of the pleural cavity and a trans-bronchial biopsy was performed, and primary lung adenocarcinoma was diagnosed. Abdominal CT showed a left enlarged adrenal gland. Because pneumothorax was resistant to the treatment by closed drainage, a surgical treatment was performed. Since the main tumor of left upper lobe was adjacent to emphysematous bullae, simple bullectomy was not possible. Accordingly, left upper lobectomy, partial resection of left lower lobe and lymph node dissection were performed. Positron emission tomography( PET)-CT after surgery strongly suggested adrenal gland metastasis and the pathological stage Ⅳ was established in combination with the histopathological examination. Appropriate surgical approach must be considered even for case with the advanced lung cancer, like present case.
一名76岁男性因呼吸困难和左侧胸痛入住我院。胸部X线片显示左侧气胸。胸部计算机断层扫描（CT）显示左肺S3有肿块影，S10有结节影。进行了胸腔引流和经支气管活检，诊断为原发性肺腺癌。腹部CT显示左侧肾上腺肿大。由于气胸对闭式引流治疗无效，遂行手术治疗。由于左上叶主要肿瘤与肺气肿大疱相邻，无法行单纯肺大疱切除术。因此，行左上叶切除术、左下叶部分切除术及淋巴结清扫术。术后正电子发射断层扫描（PET）-CT强烈提示肾上腺转移，结合组织病理学检查确定为病理Ⅳ期。对于像本病例这样的晚期肺癌病例，也必须考虑适当的手术方式。
