雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Kokyu to Junkan Volume 59, Issue 7 （July 2011）

呼吸と循環 59巻7号（2011年7月発行）

Japanese English

症例

21G穿刺針を用いた超音波気管支鏡ガイド下針生検(EBUS-TBNA)が診断に有用であった鼻咽頭癌縦隔リンパ節転移の1例 A Case of Nasopharyngeal Cancer Metastasis to the Mediastinal Lymph Nodes,in which an Endobronchial Ultrasound-guided Transbronchial Needle Aspiration(EBUS-TBNA)using a 21G Puncture Needle was Effective for Making a Diagnosis 出雲雄大 ¹ , 兼村俊範 ² , 切士紗織 ¹ , 宮本由香里 ¹ , 奥出梓 ¹ , 永井智仁 ¹ , 玉置淳 ¹ , 永井厚志 ¹ Takehiro Izumo ¹ , Toshinori Kanemura ² , Saori Kirishi ¹ , Yukari Miyamoto ¹ , Azusa Okude ¹ , Tomohito Nagai ¹ , Jun Tamaoki ¹ , Atsushi Nagai ¹ ¹東京女子医科大学第一内科 ²東京女子医科大学化学療法・緩和ケア科 ¹First Department of Medicine, Tokyo Women's Medical University, School of Medicine ²Department of Chemotherapy and Palliative Care, Tokyo Women's Medical University, School of Medicine キーワード：超音波気管支鏡ガイド下針生検 , 縦隔リンパ節腫大 , 鼻咽頭癌 , endobronchial ultrasound-guided transbronchial needle aspiration , mediastinal lymphadenopathy , nasopharyngeal carcinoma Keyword: 超音波気管支鏡ガイド下針生検 , 縦隔リンパ節腫大 , 鼻咽頭癌 , endobronchial ultrasound-guided transbronchial needle aspiration , mediastinal lymphadenopathy , nasopharyngeal carcinoma pp.731-735

発行日 2011年7月15日 Published Date 2011/7/15

DOI https://doi.org/10.11477/mf.1404101745

PDF(1147KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

要旨　患者は48歳，男性．41歳時に鼻咽頭癌に対して放射線治療施行．その後再発を認めず経過観察されていたが，2009年の胸部CTにて右#10リンパ節の腫大を指摘され，PETでは同部位以外に異常集積を認めず当科紹介．同部位で22G穿刺針と21G穿刺針にて超音波気管支鏡ガイド下針生検(EBUS-TBNA)を施行．21Gで採取された組織は肉眼的に22G穿刺針で採取された組織よりも大きく，H-E染色では多数の大きな細胞集塊が採取されていた．22G穿刺針で得られた組織は細胞がまばらで変性が強く，免疫染色を行うも原発の診断は不能であったが，21G穿刺針で得られた組織では免疫染色による診断が可能であり，既往の鼻咽頭癌縦隔リンパ節転移と診断し放射線化学療法を施行した．病変部位や既往歴などを考慮し，適切な穿刺針を選択することがEBUS-TBNAによる診断には重要であると考えられた．

　This is a case of a 48-year-old male patient who underwent radiotherapy for nasopharyngeal cancer at age 41. Thereafter, recurrence was not observed;but the patient was monitored, and based on a chest CT performed in 2009, an enlargement of the 10th lymph node on the right side was observed. Based on a PET,no abnormal accumulation was observed other than that of the enlarged lymph node site, and the patient was referred to our department. Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)was performed on the site, using 22G and 21G puncture-needles. The tissue samples obtained using the 21G puncture-needle were larger than those obtained using the 22G puncture-needle macroscopically, and based on an HE staining, a number of large cell clumps were harvested. With regard to the tissue samples obtained with the 22G puncture-needle, cells were sparse and showed strong degeneration. Although immunostaining was performed, a primary diagnosis was impossible. On the contrary, for the tissue samples obtained using the 21G puncture-needle, it was possible to make a diagnosis by means of immunostaining, through which the patient was diagnosed with nasopharyngeal cancer metastasis to the mediastinal lymph nodes. The patient thereafter underwent chemoradiation therapy. It is believed that, in diagnosing by means of EBUS-TBNA, it is important to take lesion sites and patient's medical history into consideration, and to select an appropriate puncture-needles.