肺塞栓症を生じた大腿脂肪肉腫の1例

Pulmonary Embolism Caused by Liposarcoma of the Thigh : Case Report

　抄録：症例は61歳，女性．15年前より右大腿部に腫瘤があることに気づいていたが放置していた．誘因なく労作時呼吸困難が生じ，次第に安静時にも認めるようになり当院救急外来を受診した．胸部X線像で左上葉の透過性亢進，軽度の心拡大がみられ，心エコーで右室の著明な拡大を認めた．肺血流シンチで左肺の血流低下がみられ，静脈造影では右大腿静脈は描出されず右大腿静脈に生じた血栓による肺塞栓症と診断された．ウロキナーゼとヘパリン点滴静注が開始され呼吸困難は解消した．右大腿内側の軟部腫瘍が大腿静脈を圧排し，血栓が形成されたと考え腫瘍切除術を施行した．大腿動脈と大腿静脈は腫瘍と癒着し，圧排されていた．病理学的診断は脂肪肉腫であった．切除縁が一部辺縁切除であったため放射線療法を施行した．術後7年11カ月の現在再発転移はなく，下腿に軽度の浮腫を認めるが，膝関節可動域制限はなく無病生存中である．

　A 61-year-old woman with a mass on the inner aspect of her right thigh that had grown larger over the past 15 years experienced the sudden onset of dyspnea that became increasingly severe. She was admitted to our hospital as an emergency. The initial chest X-ray revealed an increased radiolucency in the left upper lung field and blood gas analysis showed an evidence of severe respiratory distress (PaO2 50mmHg, PaCO2 23mmHg). Echocardiography revealed a severely dilated right ventricle and perfusion lung scanning showed multiple perfusion defects in both lungs. The right femoral vein was not visualized during lower limb venography. The clinical diagnosis was pulmonary embolism and it was confirmed by these examinations. The pulmonary embolism was successfully treated by intravenous anticoagulation. After treatment, the patient was introduced to our department. Since we suspected that soft-tissue tumor in the right thigh that was compressing the femoral vein had promoted thrombosis, we resected the tumor and the femoral vein as well, because it was firmly adherent to the tumor. Histological examination showed the tumor to be a liposarcoma. Postoperative radiation therapy was performed, because the tumor was resected with an insufficientry wide margin. The patient is alive and well, with no evidence of recurrent disease as of 7 years and 11months of follow-up.