Kasai Suguru, Yasumoto Kazuo, Motono Nozomu, Uramoto Hidetaka, Oda Minako, Motoo Yoshiharu
Dept. of Medical Oncology, Kanazawa Medical University Hospital.
Gan To Kagaku Ryoho. 2018 Nov;45(11):1637-1639.
Here we report the case of an 88-year-old female with serious respiratory discomfort who exhibited significant heart enlargement and left pleural effusion in her chest X-ray. She developed cardiac tamponade with massive pericardial effusion, and the cytological analysis and diagnostic imaging revealed adenocarcinoma of an unknown primary site. Although supportive care was offered, due to her super-age and malignant pericardial effusion presenting cardiac tamponade, she and her family requested a detailed examination and active treatment. She was enrolled into our medical oncology department, and we immediately performed a cell block cytological examination procedure and drained the pleural effusion. The immunohistochemical and FISH analyses revealed anaplastic lymphoma kinase(ALK)-rearranged non-small cell lung cancer. An ALK tyrosine kinase inhibitor, alectinib, was administered and resulted in a prompt and effective improvement in clinical outcome. This case indicates that we should attempt to achieve an accurate diagnosis, even when patients are super-aged and exhibit serious progress disease conditions. The pleural effusion cell block analysis may be highly useful for the prompt and precise diagnosis of malignancies.
在此，我们报告一例88岁女性病例，该患者有严重的呼吸不适，胸部X光显示心脏显著增大和左侧胸腔积液。她发展为大量心包积液导致的心包填塞，细胞学分析和诊断成像显示为原发部位不明的腺癌。尽管给予了支持治疗，但由于她年事已高且恶性心包积液导致心包填塞，她和家人要求进行详细检查和积极治疗。她被收治入我们的肿瘤内科，我们立即进行了细胞块细胞学检查并引流了胸腔积液。免疫组化和FISH分析显示为间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌。给予ALK酪氨酸激酶抑制剂阿来替尼治疗，临床结果迅速得到有效改善。该病例表明，即使患者年事已高且病情进展严重，我们也应努力实现准确诊断。胸腔积液细胞块分析对于迅速、准确地诊断恶性肿瘤可能非常有用。
