内容紹介
A Case of Pleomorphic Malignant Fibrous Histiocytoma with Multiple Lung Metastases with Bilateral Pneumothorax after Chemotherapy
Summary
A 70-year-old man diagnosed with pleomorphic malignant fibrous histiocytoma of the left thigh underwent tumor resection. After 10 months, he underwent extended resection due to local recurrence. However, because multiple lung metastases was detected at this time, chemotherapy with ifosfamide and doxorubicin was administered. After three courses of chemotherapy, the lung metastases enlarged and the patient received ifosfamide and etoposide as second line chemotherapy. Even after three courses of second line treatment, the disease progressed, for which docetaxel and gemcitabine were administered as third line chemotherapy. After three courses of third line treatment, multiple lung metastases reduced and were replaced with scar and cystic lesions(reduction ratio 85.9%). After four courses of treatment, the patient developed left pneumothorax. Partial resection of the left upper lobe was performed by thoracoscopic surgery. Histopathological examination revealed rupture of the visceral pleura in a scar lesion leading to air leakage. After 13 courses of treatment, he developed right pneumothorax. Partial resection of the right middle lobe was performed. Histopathological examination revealed a cystic lesion without tumor remnants. After 15 courses of third line treatment, lung metastasis could be controlled. Chemotherapy with docetaxel and gemcitabine resulted in few adverse effects that were within tolerance limits.
要旨
症例は70歳,男性。2011年6月,左大腿部pleomorphic malignant fibrous histiocytoma(多形型MFH)にて腫瘍広範囲切除術を施行された。10か月後,局所再発のため局所再発部広範囲切除術を施行された。同時に多発肺転移を認め,イホスファミド+ドキソルビシン療法を行った。3コース終了後,肺転移が増大しPDと診断した。二次治療としてイホスファミド,エトポシドの投与を行った。3コース後,多発肺転移が増大しPDと診断,三次治療としてドセタキセル+ゲムシタビン投与を開始した。3コース後,多発肺転移巣は縮小し瘢痕・空洞化していた(縮小率85.9%)。4コース後,左気胸を合併し,胸腔鏡下に左上葉部分切除術を施行した。術後病理診断にて術中気瘻を認め,化学療法により瘢痕化した病変では胸膜の破綻が認められた。13コース施行後,右気胸を認め,胸腔鏡下に右中葉部分切除術を施行した。術後病理診断にて術中気瘻を認めた嚢胞病変は,腫瘍の遺残を認めなかった。15コース施行したが重篤な副作用は認めず,PRが継続している。
目次
Summary
A 70-year-old man diagnosed with pleomorphic malignant fibrous histiocytoma of the left thigh underwent tumor resection. After 10 months, he underwent extended resection due to local recurrence. However, because multiple lung metastases was detected at this time, chemotherapy with ifosfamide and doxorubicin was administered. After three courses of chemotherapy, the lung metastases enlarged and the patient received ifosfamide and etoposide as second line chemotherapy. Even after three courses of second line treatment, the disease progressed, for which docetaxel and gemcitabine were administered as third line chemotherapy. After three courses of third line treatment, multiple lung metastases reduced and were replaced with scar and cystic lesions(reduction ratio 85.9%). After four courses of treatment, the patient developed left pneumothorax. Partial resection of the left upper lobe was performed by thoracoscopic surgery. Histopathological examination revealed rupture of the visceral pleura in a scar lesion leading to air leakage. After 13 courses of treatment, he developed right pneumothorax. Partial resection of the right middle lobe was performed. Histopathological examination revealed a cystic lesion without tumor remnants. After 15 courses of third line treatment, lung metastasis could be controlled. Chemotherapy with docetaxel and gemcitabine resulted in few adverse effects that were within tolerance limits.
要旨
症例は70歳,男性。2011年6月,左大腿部pleomorphic malignant fibrous histiocytoma(多形型MFH)にて腫瘍広範囲切除術を施行された。10か月後,局所再発のため局所再発部広範囲切除術を施行された。同時に多発肺転移を認め,イホスファミド+ドキソルビシン療法を行った。3コース終了後,肺転移が増大しPDと診断した。二次治療としてイホスファミド,エトポシドの投与を行った。3コース後,多発肺転移が増大しPDと診断,三次治療としてドセタキセル+ゲムシタビン投与を開始した。3コース後,多発肺転移巣は縮小し瘢痕・空洞化していた(縮小率85.9%)。4コース後,左気胸を合併し,胸腔鏡下に左上葉部分切除術を施行した。術後病理診断にて術中気瘻を認め,化学療法により瘢痕化した病変では胸膜の破綻が認められた。13コース施行後,右気胸を認め,胸腔鏡下に右中葉部分切除術を施行した。術後病理診断にて術中気瘻を認めた嚢胞病変は,腫瘍の遺残を認めなかった。15コース施行したが重篤な副作用は認めず,PRが継続している。