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Brain and Nerve No to Shinkei Volume 44, Issue 8 （August 1992）

Brain and Nerve 脳と神経 44巻8号（1992年8月発行）

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症例報告

Eaton-Lambert症候群を合併した肺癌の脳転移の1例 Brain Metastasis of Lung Cancer with Eaton-Lambert Syndrome : Case Report 原田克彦 ^1,3 , 杉田保雄 ¹ , 川場知幸 ¹ , 徳永孝行 ¹ , 重森稔 ¹ , 姉川繁敬 ² Katsuhiko Harada ^1,3 , Yasuo Sugita ¹ , Tomoyuki Kawaba ¹ , Takayuki Tokunaga ¹ , Minoru Sigemori ¹ , Shigetaka Anegawa ² ¹久留米大学脳神経外科 ²聖マリア病院脳神経センター ³田代医院 ¹Department of Neurosurgery, Kurume University School of Medicine ²Department of Neurosurgery, Institute of Neuroscience, St. Mary's Hospital キーワード： Eaton-Lambert syndrome , brain metastasis , lung cancer , lymphnodes Keyword: Eaton-Lambert syndrome , brain metastasis , lung cancer , lymphnodes pp.755-759

発行日 1992年8月1日 Published Date 1992/8/1

DOI https://doi.org/10.11477/mf.1406900374

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Abstract 文献概要
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　Eaton-Lambert症候群（以下ELS）を呈した肺癌の脳転移の1例を報告した。45歳の男性で全身倦怠感を主訴に近医を受診し，胸部異常陰影を指摘され当大学外科に入院した。入院後臨床症状と筋電図所見からELSと診断され肺癌の摘出術が施行された。手術は縦隔と肺門リンパ節の広範な切除も行われ，術後にELSの症状は完全に消失した。8カ月後に頭蓋内圧亢進症状を主訴に脳外科に入院し，転移性脳腫瘍が疑われ全摘出術が行われた。病理組織所見は，肺癌と同様に小細胞癌であった。ELSの発生を考えるうえで興味深い症例と思われる。すなわち，肺癌の摘出後依然として体内には小細胞癌が存在し成長していたにもかかわらず，ELSの症状は完全に消失していたためである。本症例の臨床経過から，小細胞癌が近接リンパ節（縦隔リンパ節）を刺激または破壊することが．ELS発症のtriggerである可能性も考えられた。

A case of brain metastasis of lung cancer with Eaton-Lambert syndrome (ELS) is reported.

A 45-year-old male was admitted to the Depart-ment of Surgery in Kurume University Hospital on November 13, 1985, complaining of general fatigue. On admission, neurological examination revealed diplopia and fatigue of the extremities. The electromyogram (EMG) showed the waning phe-nomenon in low frequency repetitive stimulation (2Hz) and the waxing phenomenon in high fre-quency repetitive stimulation (10Hz, 20Hz). His clinical symptoms, radiological findings and EMG findings demonstrated lung cancer with ELS. Leftpulmonary lobectomy with lymphnode dissection of the anterior mediastinum and pulmonary hilus was performed on December 4. Intraoperatively, the tumor was strongly adherent to a medium lymphnode. The patient experienced complete relief symptoms due to ELS. Histological examination disclosed a small cell carcinoma without lymphnode metastasis. He was discharged without any neuro-logical deficits following chemotherapy on February 27, 1986.

He was readmitted to the Department of Neuro-surgery on August 29, 1986, because of the develop-ment of nausea and vomiting. Neurological exami-nation demonstrated no abnormalities except for choked disc in the bilateral ocular fundi. The computed tomography scan revealed a metastatic brain tumor with a mural nodule and cyst. The tumor was totally removed on September 2. His-tological examination revealed a typical appear-ance of small cell carcinoma. He followed a satis-factory postoperative course. He was discharged following radiation therapy on November 2, 1986, and was followed as an outpatient. He has no prob-lem in daily life since then.

Though the patient had an expanding metastatic brain tumor from lung cancer after the first opera-tion, he experienced no symptoms due to ELS. His clinical course and findings suggested that the manifestation of ELS was due to lymphnode stimu-lation by the neoplasm.