両側肺野に多発結節影を呈したPulmonary Langerhans'-Cell Histiocytosisの1例

Pulmonary Langerhans'-Cell Histiocytosis with Multiple Nodular Lesions in Both Lung Fields: Acase report

要旨　患者は喫煙歴（40本/日×31年）のある51歳，男性．発熱，胸部痛を主訴に来院．CTにて両側肺野にびまん性に散在する結節影を認めたが，診断はっかず症状も自然に消失したため経過観察とした．その後，胸部の結節影は明らかに増加・増大傾向を認めたため，胸腔鏡下肺生検を施行しPulmonary Langerhans'-Cell Histiocytosis（Pulmonary LCH）と診断した．確定診断後は禁煙指導のみ行ったが，肺野の結節影は消槌傾向を示した．Pulmonary LCHは報告数自体が少なく，不明な点も多い．本症例は，Pulmonary LCHに多く認められる嚢胞状陰影がみられなかった点で，同疾患のなかでも珍しい1例と考えられた．

　A 51-year-old male, with a history of smoking 40 cigarettes per day for 31 years, came to the hospital complaining of fever and chest pain. The CT scan showed diffuse nodular lesions in both lung fields. We suspected malignancy or infection but could not make a definite diagnosis. Because his symptom improved spontaneously, he was observed without treatment. Afterwards, however, the nodular lesions increased in number and became larger in size, so we performed thoracoscopic lung biopsy, and then made a diagnosis of Pulmonary Langerhans'-Cell Histiocytosis (Pulmonary LCH). After diagnosis, the nodular lesions became fewer and smaller due apparently only to the patients' giving up smoking. The number of reported cases of Pulmonary LCH has been insufficient to supply much data about this disease and a lot of points need to be cleared up. We regard our case as quite rare among cases of Pulmonary LCH especially because, in this case, there were no cystic lesions in the lung fields. In other cases the presence of cystic lesions was observed.