術中気管支鏡が有用であった気管支鋳型陰影を伴う転移性肺腫瘍

Metastatic Lung Tumor with Bronchial Cast Shadow in Which Intraoperative Bronchoscopy Was Useful During Robotic Surgery

肺腫瘍が気管支内腔にポリープ状に進展をきたすことは知られている．ポリープ状発育を示す肺腫瘍は良性・悪性腫瘍など多様である1，2）．

A man in his 60s, who had undergone surgery for rectal cancer, liver metastases, and lung metastasis, had a past history of myocardial infarction and ventricular fibrillation with reduced cardiac functions. He was referred to our department because of a pulmonary nodule shadow in the S2 right upper lobe and a bronchial cast shadow along the B2 bronchus. Robot-assisted thoracoscopic right S2 segmentectomy was performed and intraoperative bronchoscopy revealed a polyp-like tumor within B2a. Then, B2a and B2b were resected and the tumor was removed into the surgical field. It was confirmed that there was no residue using a bronchoscope, and the bronchus was cut on the proximal side of B2 using an automatic suturing device. The final pathological diagnosis was rectal cancer with lung metastasis, and the endobronchial tumor showed necrotic tissue and bronchial stumps were negative.