Jackson D, Greenberg S D, Howell J F
Cancer. 1984 Jul 15;54(2):361-6. doi: 10.1002/1097-0142(19840715)54:2<361::aid-cncr2820540231>3.0.co;2-i.
The presence of scar tissue associated with peripheral pulmonary carcinomas has always evoked considerable interest. This report concerns a unique case of a 55-year-old white oil-field worker whose right pneumonectomy specimen disclosed two primary pulmonary scar cancers, involving both upper and lower lobes. Both carcinomas arose at the margins of pleural-based scars. The malignancy in the right upper lobe was a 2.5-cm large cell carcinoma, while that in the right lower lobe was a 2.0-cm adenocarcinoma. The bronchial and hilar lymph nodes were free of metastases. One month following pneumonectomy the patient suffered a cardiac arrest, and necropscopic examination failed to reveal evidence of metastases. Controversy continues concerning whether the scar precedes or follows the development of peripheral pulmonary carcinomas. Several recent studies favoring the latter theory have suggested that the scar is immunologically related to the carcinoma. In the current case, the pleural-based upper lobe scar was associated with an old, inactive granuloma, while the lower lobe pleural-based scar disclosed no clue as to its origin. The adenocarcinoma in the lower lobe might possibly be immunologically related to its associated scar; however, it would appear difficult to account for the scar of the upper lobe large cell carcinoma by a similar mechanism.
与周围型肺癌相关的瘢痕组织的存在一直引发着人们极大的兴趣。本报告涉及一例独特病例，一名55岁的白人油田工人，其右肺切除标本显示有两个原发性肺瘢痕癌，累及上叶和下叶。这两个癌均发生在胸膜下瘢痕的边缘。右上叶的恶性肿瘤是一个2.5厘米的大细胞癌，而右下叶的是一个2.0厘米的腺癌。支气管和肺门淋巴结无转移。肺切除术后一个月，患者发生心脏骤停，尸检未发现转移证据。关于瘢痕是先于还是后于周围型肺癌的发生仍存在争议。最近一些支持后一种理论的研究表明，瘢痕与癌在免疫上相关。在当前病例中，胸膜下上叶瘢痕与一个陈旧的、不活动的肉芽肿有关，而下叶胸膜下瘢痕则未显示其起源线索。下叶的腺癌可能在免疫上与其相关瘢痕有关；然而，通过类似机制似乎难以解释上叶大细胞癌的瘢痕。
