Suzuki Takafumi, Furusawa Haruhiko, Watanabe Yuta, Sakashita Hiroyuki, Fujii Shinya, Tasaka Yuri, Shimada Sho, Majima Hidetaka, Kawahara Tatsuo, Katayanagi Shinji, Ejima Masaru, Nukui Yoshihisa, Shirai Tsuyoshi, Masuo Masahiro, Tateishi Tomoya, Fujie Toshihide, Tamaoka Meiyo, Taguchi Towako, Tomii Shohei, Miyazak Yasunari
Dept. of Respiratory Medicine, Tokyo Medical and Dental University.
Gan To Kagaku Ryoho. 2019 Feb;46(2):267-270.
Pulmonary enteric adenocarcinoma is a unique pulmonary adenocarcinoma subtype and has histopathological findings that are similar to those of colorectal adenocarcinoma. A man in his 50s visited our hospital because of discomfort in his right lower leg for the last 9 months. Imaging studies revealed a mass in his right soleus muscle, and needle biopsy was performed. Histological findings revealed adenocarcinoma, and immunohistochemical staining showed that the tumor cells were positive for CK20 and CDX-2. The tumor was first suspected to be metastasis of gastrointestinal malignant tumors. FDG-PET/CT showed increased FDG uptake in the right soleus muscle mass and presented with increased FDG uptake in a right upper lobe mass and right mediastinum lymphadenopathy. There were no findings in other organs. Scraping cytology of a transbronchial biopsy indicated adenocarcinoma. Upper and lower gastrointestinal endoscopy showed no findings of malignancy. He was finally diagnosed with pulmonary enteric adenocarcinoma(cT3N2M1b, Stage ⅣA). Treatment with cisplatin(CDDP), pemetrexed( PEM), and bevacizumab(BEV) was initiated. After 4 courses of the regimen, the tumor was partially reduced, and the patient showed stable disease(SD).
肺肠型腺癌是一种独特的肺腺癌亚型，具有与结直肠腺癌相似的组织病理学表现。一名50多岁的男性因右下肢不适9个月就诊于我院。影像学检查显示右比目鱼肌有肿块，并进行了针吸活检。组织学检查发现腺癌，免疫组化染色显示肿瘤细胞CK20和CDX-2呈阳性。该肿瘤最初怀疑是胃肠道恶性肿瘤的转移。氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）显示右比目鱼肌肿块处FDG摄取增加，右上叶肿块和右纵隔淋巴结肿大处也有FDG摄取增加。其他器官未发现异常。经支气管活检的刮片细胞学检查提示腺癌。上、下消化道内镜检查未发现恶性病变。他最终被诊断为肺肠型腺癌（cT3N2M1b，ⅣA期）。开始使用顺铂（CDDP）、培美曲塞（PEM）和贝伐单抗（BEV）进行治疗。经过4个疗程的治疗方案后，肿瘤部分缩小，患者病情稳定（SD）。
