Nakajima Yuki, Akiyama Hirohiko, Kinoshita Hiroyasu, Atari Maiko, Fukuhara Mitsuro, Sakai Hiroshi, Uramoto Hidetaka
Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
Int J Surg Case Rep. 2016;18:5-8. doi: 10.1016/j.ijscr.2015.11.027. Epub 2015 Nov 28.
When considering treatment for pulmonary cancer complicated by interstitial pneumonia, the greatest problem is acute exacerbation. We report two cases of pulmonary cancer complicated by interstitial pneumonia in which multiple intrapulmonary lymph nodes were noted.
Cases 1 and 2 were 76- and 62-year-old males, respectively. Both cases were diagnosed as pulmonary cancer complicated by interstitial pneumonia, and upon chest CT, it was noted that, in addition to the primary lesions, there were multiple nodule shadows under the pleura in the lung lobe, which required identification in order to rule out lung metastasis. In Case 1, the pulmonary nodules were first resected during surgery and a swift diagnosis was made, determining them to be intrapulmonary lymph nodes, which were then operated on curatively. In Case 2, the patient underwent thoracoscopic observation during surgery, the shadows were diagnosed visually as intrapulmonary lymph nodes, and curative surgery was implemented.
The greatest problem in treating pulmonary cancer complicated with interstitial pneumonia is acute exacerbation, wherein, in the absence of any surgical indications, alternative treatment is limited. Thus, contra-indicating surgery for a patient due to a diagnosis of metastasis within the lungs, based only on nodule images, should be avoided. If nodules are noted in the area of the pleura, the possibility exists that these could be intrapulmonary lymph nodes, along with metastasis within the lung, and thoracoscopic surgery should be implemented proactively while keeping these in mind.
在考虑对合并间质性肺炎的肺癌进行治疗时，最大的问题是急性加重。我们报告两例合并间质性肺炎的肺癌病例，其中发现了多个肺内淋巴结。
病例1和病例2分别为76岁和62岁男性。两例均被诊断为合并间质性肺炎的肺癌，胸部CT显示，除原发灶外，肺叶胸膜下有多个结节影，需要鉴别以排除肺转移。病例1中，肺结节在手术中首先被切除并迅速确诊为肺内淋巴结，随后进行了根治性手术。病例2中，患者在手术中接受了胸腔镜观察，阴影经肉眼诊断为肺内淋巴结，并实施了根治性手术。
治疗合并间质性肺炎的肺癌时最大的问题是急性加重，在没有任何手术指征的情况下，替代治疗有限。因此，仅根据结节影像诊断为肺内转移而对患者进行手术禁忌应避免。如果在胸膜区域发现结节，有可能这些是肺内淋巴结，同时存在肺内转移，应在牢记这些情况的同时积极实施胸腔镜手术。
