Yokouchi Hideoki, Murata Kohei, Murakami Masahiro, Okada Kazuyuki, Ebisui Chikara, Okamura Shu, Yanagisawa Tetsu, Nishigaki Takahiko, Owada Yoshiyuki, Katoh Ryou, Makino Shunichiro, Kinuta Masakatsu, Tamai Masamitsu
Dept. of Surgery, Suita Municipal Hospital, Japan.
Gan To Kagaku Ryoho. 2012 Nov;39(12):2396-8.
A female never-smoker in her 60s presented with persistent productive cough. Chest radiography and computed tomography revealed widespread consolidation in the basal area of her left lung lower lobe. She received antibiotics and steroid therapy. Nevertheless, consolidation extended over the left lower lobe, and multiple nodular shadows appeared in both the lungs until a histological diagnosis of adenocarcinoma was obtained with lung wedge resection biopsy. Left lower lobectomy was performed as a tumor reduction surgery to palliate dyspnea due to massive sputum. The duration of decreased sputum production was short, and the lesion spread rapidly over the residual lung, resulting in death due to respiratory failure 8 months after her first visit. The histological diagnosis was diffuse pneumonic type of invasive mucinous adenocarcinoma with lepidic, acinar, and solid growth patterns (formerly mucinous bronchioloalveolar cell carcinoma). Mucous sputum containing tumor cells tends to spread aerogenously to other lobes and both lungs, and thus, disease control is difficult. Although there are some case reports of successful treatment with oral epidermal growth factor receptor tyrosine kinase inhibitors or pemetrexed, an effective therapeutic strategy for this type of lung cancer has not been established.
一名60多岁从不吸烟的女性因持续咳痰前来就诊。胸部X线和计算机断层扫描显示左肺下叶基底区域广泛实变。她接受了抗生素和类固醇治疗。然而，实变蔓延至左肺下叶，双肺出现多个结节状阴影，直至通过肺楔形切除活检获得腺癌的组织学诊断。由于大量痰液导致呼吸困难，行左下肺叶切除术作为减瘤手术。咳痰减少的持续时间较短，病变在残余肺组织中迅速扩散，导致初诊8个月后因呼吸衰竭死亡。组织学诊断为弥漫性肺炎型侵袭性黏液腺癌，具有鳞屑状、腺泡状和实性生长模式（以前称为黏液性细支气管肺泡癌）。含有肿瘤细胞的黏液痰易于通过空气传播至其他肺叶和双肺，因此疾病控制困难。尽管有一些口服表皮生长因子受体酪氨酸激酶抑制剂或培美曲塞成功治疗的病例报告，但尚未确立针对这种类型肺癌的有效治疗策略。
