胸腔内子宮内膜症14例の臨床的検討

Clinical Assessment of Fourteen Cases of Thoracic Endometriosis

子宮内膜症は子宮内腔以外に子宮内膜組織が発生して発育する疾患であり，子宮外壁・卵巣・直腸・膀胱などの骨盤内臓器に好発する．一方，胸郭内に発生するものは約2％とまれであり1），そのほとんどが横隔膜や胸膜に発生し，月経周期に合致して気胸や血痰を呈する．その複雑な発生機序による診断のむずかしさ，他科との連携，若年発症であるがゆえの妊孕性の確保などが問題となる．

We retrospectively assessed the clinical and pathological features of 14 patients with thoracic endometriosis who were treated at our hospital from 2007 to 2017. Thirteen patients presented pneumothorax and 1 patient presented bloody sputum. All were treated surgically. Pneumothorax occurs on the right side in all 13 cases and bloody sputum was from left side lesion. Ten patients presented symptoms closely related with their menstrual cycle （days -2 to 5）. At surgery, dark red or dark brown spots, small hiatus and scar-like findings on the surface of the visceral pleura or diaphragm were identified in all cases. Pathological or immunohistochemical examinations of diaphragm or lung tissue specimens revealed endometrial tissue in 6 cases of pneumothorax and a case of bloody sputum. Nine patients received hormonal therapy（8：pneumothorax, 1：bloody sputum）. Pleurodesis was performed for 1 pneumothorax patient with recurrent pneumothorax after hormonal therapy. In case of young female with repeated pneumothorax, catamenial pneumothorax must be kept in mind as a differential diagnosis and appropriate timing for surgical treatment should be considered to establish pathologically correct diagnosis.