二度の局所再発切除後に対側肺に転移した巨大孤立性線維性腫瘍

Giant Solitary Fibrous Tumor of Pleura Metastasizing Contralateral Lung Following Two Times of Surgery for Ipsilateral Pleural Disseminations

孤立性線維性腫瘍（SFT）は間葉系細胞から発生するまれな腫瘍である．予後は良好な腫瘍であるが，まれに再発を認める場合がある．われわれは，低血糖発作を契機に発見された右胸腔を占拠する巨大SFTに対し手術を行い，低血糖発作は消失したが，経過観察中に同側胸膜播種を認め，2回手術を行うも最終的に対側肺転移を認め，再発巣の増大に伴い低血糖も再燃した症例を経験したため報告する．

We report a case of giant solitary fibrous tumor （SFT） of pleura metastatising contralateral lung following 2 times of surgery for ipsilateral pleural disseminations. A 70-year-old woman was carried to our hospital by ambulance because of hypoglycemic attack. A chest X-ray film showed a huge mass in the right lung field. A computed tomography guided biopsy revealed a SFT producing IGF-Ⅱ, which caused hypoglycemic attack. After surgery, she was relieved of hypoglycemic attack and discharged from the hospital 14 days following the surgery. SFT repeatedly relapsed in the ipsilateral pleura. In the follow-up period, 2 times of resection of disseminated nodules were carried out. Finally, SFT developed ipsilateral pleural disseminations and contralateral pulmonary metastases, accompanying hypoglycemic attack. She died 76 months after the initial surgery.