検診における胸部X線像から発見された前立腺癌

Prostatic cancer discovered in chest X-ray performed on medical examination treated successfully with hormonal therapy：A case report

　症例は71歳，男性。老人健診の胸部X線で多発性肺腫瘍を指摘された。転移性肺腫瘍が疑われ，原発巣検索のためCTを施行し，骨盤内に7.5×5.5cmの充実性腫瘤を認めた。同腫瘤の生検にて前立腺中分化腺癌リンパ節転移と診断された。PSAは3,100ng/mlと高値を示しており，骨シンチにて左坐骨に集積を認めた。前立腺癌Stage D2（T4，N1，M1c）の診断のうえ，内分泌療法（diethylstilbestrol diphosphate，LH-RH agonist）を施行し，肺転移巣は消失した。骨盤内リンパ節転移に対しては放射線治療も追加し2.5×3.0cmと縮小した。治療10か月後の現在，PSAは0.2ng/ml以下で再燃なく経過している。

We report a case of prostatic cancer in a 71-year-old man detected by multiple pulmonary nodules in chest X-ray performed on medical checkups. Intrapelvic tumor in the size of 7.5×5.5cm was also detected on CT and histological diagnosis of needle biopsy of the tomor was moderately differentiated adenocarcinoma of the prostate. Serum PSA level was 3,100ng/ml. Under the diagnosis of prostatic cancer with pulmonary,lymphnode,and bone metastasis,hormonal therapy of diethylstilbestrol（DES）and LH-RH agonist was started. After three months,pulmonary nodules disappeared on chest X-ray and pelvic lymphnodes metastasis decreased markedly on CT. After six months,PSA level decreased to below 0.2ng/ml. After ten months,he is now alive and free from the recurrence.