内容紹介
A Case of cStage ⅢB Non-Squamous Non-Small-Cell Lung Cancer Completely Resected after Downstaging with Chemotherapy
Summary
A 64-year-old man was diagnosed with a gastric ulcer, and a tumor shadow was observed in the right lower lung field on a chest radiograph. Chest computed tomography(CT)revealed the tumor shadow to be 33×25 mm in the right lower lobe; it also revealed a 7-mm nodule in the right S3, and lymph node swelling in the upper and lower mediastinum. Positron emission tomography(PET)-CT revealed an SUVmax of 12.8, 1.2, 7.6, and 10.0 for the right lower lobe tumor, right S3 nodule, and the No. 4 and No. 7 lymph nodes, respectively. The right lower lobe tumor was diagnosed as an adenocarcinoma via transbronchial lung biopsy. The patient was diagnosed with cT4N2M0, cStage ⅢB cancer. Four courses of carboplatin, pemetrexed, and bevacizumab were administered. After the fourth course, chest CT revealed that the right lower lobe tumor and the right S3 nodule significantly reduced to 14×7 mm and 5 mm respectively, and the mediastinal lymph node swelling was nearly eliminated. Subsequent PET-CT examination revealed an SUVmax of 1.3 and 0.8 in the right lower lobe tumor and right S3 nodule, respectively. The patient was diagnosed with ycT4N0M0, ycStage ⅢA cancer, and he underwent right lower lobe resection, right S3 partial resection, and lymph node. Postoperative pathological analysis was used to make a diagnosis of mixed type adenocarcinoma for the right lower lobe tumor, and a diagnosis of papillary adenocarcinoma for the right S3 nodule. Both tumors were diagnosed as primary lung cancers. There were no metastatic cancer cells in the dissected lymph nodes.
要旨
症例は64歳,男性。胃潰瘍加療中,右下肺野に塊状影を認めた。胸部CTにて右下葉に33×25 mm,右S3に7 mm結節影,縦隔リンパ節腫脹を認めた。気管支鏡下生検にて腺癌と診断,cT4N2M0,cStage ⅢBとして,カルボプラチン,ペメトレキセド,ベバシズマブ投与を4コース施行した。右下葉腫瘍は14×7 mm,右S3結節は5 mmに縮小,縦隔リンパ節はほぼ消失した。ycT4N0M0,ycStage ⅢAと診断し,右下葉切除術,ND2a-2,右S3部分切除術を施行した。病理診断にて,右下葉腫瘍は混合型腺癌でEf1b,右上葉結節は乳頭型腺癌でEf1a,多発癌と診断された。リンパ節に転移性癌細胞の遺残は認めなかった。
目次
Summary
A 64-year-old man was diagnosed with a gastric ulcer, and a tumor shadow was observed in the right lower lung field on a chest radiograph. Chest computed tomography(CT)revealed the tumor shadow to be 33×25 mm in the right lower lobe; it also revealed a 7-mm nodule in the right S3, and lymph node swelling in the upper and lower mediastinum. Positron emission tomography(PET)-CT revealed an SUVmax of 12.8, 1.2, 7.6, and 10.0 for the right lower lobe tumor, right S3 nodule, and the No. 4 and No. 7 lymph nodes, respectively. The right lower lobe tumor was diagnosed as an adenocarcinoma via transbronchial lung biopsy. The patient was diagnosed with cT4N2M0, cStage ⅢB cancer. Four courses of carboplatin, pemetrexed, and bevacizumab were administered. After the fourth course, chest CT revealed that the right lower lobe tumor and the right S3 nodule significantly reduced to 14×7 mm and 5 mm respectively, and the mediastinal lymph node swelling was nearly eliminated. Subsequent PET-CT examination revealed an SUVmax of 1.3 and 0.8 in the right lower lobe tumor and right S3 nodule, respectively. The patient was diagnosed with ycT4N0M0, ycStage ⅢA cancer, and he underwent right lower lobe resection, right S3 partial resection, and lymph node. Postoperative pathological analysis was used to make a diagnosis of mixed type adenocarcinoma for the right lower lobe tumor, and a diagnosis of papillary adenocarcinoma for the right S3 nodule. Both tumors were diagnosed as primary lung cancers. There were no metastatic cancer cells in the dissected lymph nodes.
要旨
症例は64歳,男性。胃潰瘍加療中,右下肺野に塊状影を認めた。胸部CTにて右下葉に33×25 mm,右S3に7 mm結節影,縦隔リンパ節腫脹を認めた。気管支鏡下生検にて腺癌と診断,cT4N2M0,cStage ⅢBとして,カルボプラチン,ペメトレキセド,ベバシズマブ投与を4コース施行した。右下葉腫瘍は14×7 mm,右S3結節は5 mmに縮小,縦隔リンパ節はほぼ消失した。ycT4N0M0,ycStage ⅢAと診断し,右下葉切除術,ND2a-2,右S3部分切除術を施行した。病理診断にて,右下葉腫瘍は混合型腺癌でEf1b,右上葉結節は乳頭型腺癌でEf1a,多発癌と診断された。リンパ節に転移性癌細胞の遺残は認めなかった。