思春期に胸腔鏡下切除した無症候性congenital cystic adenomatoid malformationの1例

Thoracoscopic resection of asymptomatic congenital cystic adenomatoid malformation in an adolescent

◆要旨：Congenital cystic adenomatoid malformation（CCAM）は思春期や成人で発見されることは稀である．また，そのような症例は繰り返す肺炎で発見されることが多い．今回筆者らは無症状のCCAMを経験したのでこれを報告する．患者は16歳，男性．胸部異常陰影の精査加療目的に当科紹介となった．画像所見から肺囊胞病変を指摘された．完全胸腔鏡下に左下葉部分切除術を施行し，病理学的にCCAM I型と診断された．その後，3か月後のCTで囊胞の再発を指摘された．CCAMの治療は外科的切除が唯一の方法だが，無症状では手術時期について決まっていない．本症例では縦隔偏位を伴い，巨大な囊胞であったため今後感染の可能性を考え手術を施行した．部分切除のみで終了したが今後も経過観察が必要である．

Congenital cystic adenomatoid malformation（CCAM） is very rarely detected in an adolescent. In such cases, it often presents as repeated pneumonia. This report presents our experience with asymptomatic CCAM in an adolescent. A 16-year-old boy was referred to our hospital for the examination and treatment of abnormal chest shadow. Preoperative imaging studies incidentally showed cystic lung disease. The patient underwent wedge resection of the left lower lobe with video-assisted thoracoscopic surgery, and histological examination confirmed type I CCAM. The postoperative course was uneventful, and the patient was discharged on the tenth postoperative day. Three months later, a CT scan revealed the recurrence. Surgical resection is the only treatment for CCAM. However, there is no consensus on the appropriate time to perform surgical resection of asymptomatic CCAM. The case presented here, involved mediastinal displacement, and there was a risk of cyst infection. Therefore, surgical resection was performed. The patient underwent only wedge resection considering his good constructed body, which required maximum preservation of pulmonary function. He will require continued observation, because the cyst has relapsed.