肺多形癌切除の4例

Clinical Analysis of Pulmonary Pleomorphic Carcinoma：Report of Four Cases

はじめに　肺多形癌は世界保健機関（WHO）で1999年に分類・定義された腫瘍で1），肺癌取扱い規約（改訂第8版）では，「紡錘細胞あるいは巨細胞を含む扁平上皮癌，腺癌，未分化非小細胞癌，あるいは紡錘細胞と巨細胞のみからなる癌で，定義上，紡錘細胞，巨細胞の成分は腫瘍全体の10％以上を占めるものとされる」と定義される．原発性肺癌に占めるその頻度は約0.3％とされ2），中高年の男性で喫煙者に多く3），化学療法や放射線治療に抵抗性で早期に再発し予後不良とされている4～6）．このため，肺多形癌の治療は早期発見による早期手術が最善の治療法である．

Of 243 resected cases of primary non-small cell lung cancer for ten years in our hospital, we experienced 4 patients （1.6％） of pulmonary pleomorphic carcinoma. All patients were males and heavy smokers. Histologically, the vascular invasion was showed in 3 of 4 patients. In only one patient, recurrence was recognized, and he died 18 months after surgery. The other 3 patients were alive without recurrence for 86, 92, and 60 months after surgery. In general, prognosis of pulmonary pleomorphic carcinoma is very poor. But in my study, 3 of 4 patients of pulmonary pleomorphic carcinoma survive from this disease. As the planning of an appropriate treatment strategy of pulmonary pleomorphic carcinoma, further detailed assessment of adjuvant chemotherapy, such as immune check point inhibitors, will be considered to be necessary.