内容紹介
Summary
A 64-year-old man visited his physician complaining of bilateral gynecomastia and left shoulder pain. Chest X-ray showed multiple bilateral masses in the lung, and he was referred to our hospital. Radiographical findings, elevation of serum total hCG, and histological findings of the cervical lymph node revealed multiple pulmonary, nodal, and brain metastases of poorly differentiated carcinoma of an unknown primary site with choriocarcinoma components. He was administered a regimen of reduced bleomycin, cisplatin, etoposide combination(reduced BEP regimen)to reduce the risk of acute respiratory failure with intra-alveolar hemorrhage related to post-chemotherapy early tumor necrosis. After chemotherapy, the tumor marker hCG levels were almost restored to normal levels, and radiography showed he had achieved a clinical partial response.
要旨
症例は64歳,男性。両側女性化乳房,左肩関節痛を主訴に前医を受診した。胸部X線上両肺に多発腫瘤影を指摘され,精査目的で当科に紹介となった。各種画像検査,血清総hCGの上昇,頸部リンパ節生検の結果から,絨毛癌成分を含む原発不明低分化癌の多発肺・リンパ節転移,脳転移と診断した。肺転移巣からの出血による呼吸不全(絨毛癌症候群)のリスクが高いと予想されたため,減量したbleomycin,cisplatin,etoposide併用化学療法(BEP療法)により治療を開始した。同療法により血清総hCGの低下,画像上奏効が得られた。
目次
A 64-year-old man visited his physician complaining of bilateral gynecomastia and left shoulder pain. Chest X-ray showed multiple bilateral masses in the lung, and he was referred to our hospital. Radiographical findings, elevation of serum total hCG, and histological findings of the cervical lymph node revealed multiple pulmonary, nodal, and brain metastases of poorly differentiated carcinoma of an unknown primary site with choriocarcinoma components. He was administered a regimen of reduced bleomycin, cisplatin, etoposide combination(reduced BEP regimen)to reduce the risk of acute respiratory failure with intra-alveolar hemorrhage related to post-chemotherapy early tumor necrosis. After chemotherapy, the tumor marker hCG levels were almost restored to normal levels, and radiography showed he had achieved a clinical partial response.
要旨
症例は64歳,男性。両側女性化乳房,左肩関節痛を主訴に前医を受診した。胸部X線上両肺に多発腫瘤影を指摘され,精査目的で当科に紹介となった。各種画像検査,血清総hCGの上昇,頸部リンパ節生検の結果から,絨毛癌成分を含む原発不明低分化癌の多発肺・リンパ節転移,脳転移と診断した。肺転移巣からの出血による呼吸不全(絨毛癌症候群)のリスクが高いと予想されたため,減量したbleomycin,cisplatin,etoposide併用化学療法(BEP療法)により治療を開始した。同療法により血清総hCGの低下,画像上奏効が得られた。