Teraishi Fuminori, Shoji Rhohei, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery Okayama University Graduate School Okayama Japan.
Department of Minimally Invasive Therapy Center Okayama University Hospital Okayama Japan.
JGH Open. 2024 Jul 19;8(7):e70003. doi: 10.1002/jgh3.70003. eCollection 2024 Jul.
A 68-year-old woman was referred to our hospital for rectal surgery after a pathological diagnosis of rectal carcinoid with venous invasion following endoscopic submucosal dissection of a 5 mm-sized submucosal tumor in the lower rectum. Chest CT showed nodules in the left upper lobe and right lower lobe, but positron emission tomography and somatostatin receptor scintigraphy showed no hyperaccumulation in the lung nodules. CT-guided needle biopsy was performed on the nodular lesion in the left upper lobe, which showed focal growth of tumor cells with a high N/C ratio and positive synaptophysin, leading to a diagnosis of pulmonary metastasis of rectal carcinoid. Since the patient was asymptomatic and did not wish to undergo surgery or chemotherapy, she was followed up strictly with sufficient informed consent. Three years have passed since the diagnosis, and there is no tendency for the lung metastasis to increase, and no other new lesions have been observed. The disease had not progressed and remained stable. Therefore, immunohistological analysis of the lung biopsy specimen was performed again, which was positive for TTF-1 and negative for CDX2. Consequently, the diagnosis was changed to primary lung carcinoid tumors, and the patient remains under follow-up with no disease progression.
一名68岁女性因直肠类癌伴静脉侵犯接受内镜下黏膜下剥离术切除直肠下段5mm大小黏膜下肿瘤后，被转诊至我院行直肠手术。胸部CT显示左上叶和右下叶有结节，但正电子发射断层扫描和生长抑素受体闪烁扫描显示肺结节无高摄取。对左上叶结节性病变进行了CT引导下针吸活检，结果显示肿瘤细胞局灶性生长，核质比高，突触素阳性，诊断为直肠类癌肺转移。由于患者无症状且不愿接受手术或化疗，在充分知情同意的情况下对其进行了严格随访。诊断已过去三年，肺转移没有增加的趋势，也未观察到其他新病变。疾病未进展，保持稳定。因此，再次对肺活检标本进行免疫组织化学分析，结果显示甲状腺转录因子-1（TTF-1）阳性，尾型同源盒转录因子2（CDX2）阴性。因此，诊断改为原发性肺类癌肿瘤，患者仍在随访中，疾病无进展。
