肺胞上皮置換性増殖を呈し原発性肺癌を疑った膵癌多発肺転移

Lung Metastases from Pancreatic Cancer Initially Suspected to be Primary Lung Cancer due to Lepidic Tumor Growth

転移性肺癌であっても肺胞上皮置換性増殖をするものがあり，CT検査などの画像所見からは肺炎・気管支炎または気管支肺胞腺癌などと区別がつきにくいことがある．われわれは，診断にいたるまでに期間を要したすりガラス影を伴う膵癌多発肺転移の1例を経験したので報告する．

A 46-year-old patient man was pointed out multiple abnormal shadows on the chest X-ray. Computed tomography （CT） scans showed diffuse multiple granular shadows associated with ground-glass opacity in the surrounding area. Therefore, sarcoidosis or inflammatory lung disease was suspected. Bronchoscopic examination could not establish definitive diagnosis. Since an increase in the size and number of granular shadows was observed during the follow-up period, surgical biopsy was performed. Pathologically, adenocarcinoma with lepidic tumor growth into the surrounding area was observed suggesting primary lung cancer. Positron emission tomography （PET） after surgery for establishing stage of disease detected an abnormal accumulation in the pancreatic head which was demonstrated to be pancreatic cancer by biopsy. The final diagnosis of multiple lung tumor was metastases from pancreatic cancer.