Desmoplastic Malignant Pleural Mesotheliomaの1症例

A Case of Desmoplastic Malignant Pleural Mesothelioma

要旨　患者は81歳，女性．2011年5月中旬より呼吸苦が出現し，呼吸困難に左背部痛が加わったため5月18日当院へ救急搬送・入院となった．胸部CT検査で左下肺に巨大腫瘍を認め，左上肺に多量の胸水貯留を認めた．胸水細胞診で悪性所見を認めず，生検でも確定診断には至らなかった．持続胸腔ドレナージを施行していたところ，呼吸状態が悪化し，気管内挿管・人工呼吸管理となった．入院第28日，開胸手術を施行したところ，胸膜に固着する黄白色調の腫瘍を認め，可能な限り腫瘍を切除した．病理組織検査で，細胞異型を伴った紡錘状細胞の増生を認め，desmoplastic malignant pleural mesothelioma(DMM)と診断された．

　An 81-year-old woman with no history of asbestos exposure complained of dyspnea in May, 2011, and was referred to our hospital for worsening dyspnea and left back pain on May 18,2011. On admission, a chest CT revealed a giant mass in the left lower lung and massive pleural effusion in the left upper lung. Neither a cytological examination of the pleural effusion nor a histological examination of the mass revealed malignant cells. During persistent pleural drainage, her respiratory condition worsened and she was intubated and mechanically ventilated. Twenty eight days after admission, thoracotomy was performed, and a whitish yellow mass was found strongly adhering to the chest wall. The large mass was resected as much as possible. Histological examination showed spindle-shaped cells with atypia forming a storiform pattern, and the diagnosis of desmoplastic malignant pleural mesothelioma was made. Cases of desmoplastic malignant pleural mesothelioma(DMM)have been rare in Japan.