二度の胸膜再発を胸腔鏡下に摘出し長期生存の得られている胸腺腫の1例

A long-term surviving patient with thymoma who underwent resection for intrathoracic recurrent tumors under video-assisted thoracic surgery twice

◆要旨：患者は64歳，女性．49歳時，全身型重症筋無力症合併胸腺腫で，拡大胸腺胸腺腫摘出術を施行した．4年5か月後の53歳時のCTで胸壁，横隔膜上に計3個の腫瘤を認めた．胸腔鏡下に摘出し，胸腺腫胸膜再発と診断された．その3年2か月後の56歳時のCTで前胸壁に腫瘤を認めた．胸腔鏡下に摘出し，胸腺腫胸膜再発と診断された．その後7年10か月後の現在，無再発である．重症筋無力症は完全寛解している．胸腺腫の術後は，CTで経過観察し，胸膜再発が疑われた場合，積極的に胸腔鏡下手術を施行し，播種であれば完全切除を目指すことが重要であると考えられた．

　A 53-year-old woman had undergone a surgical resection for a thymoma with Myasthenia gravis （MG） 4 years 5 months previously. Chest computed tomography （CT） revealed two pleural tumors on the posterior chest wall and a pleural tumor on the diaphragm. She had undergone resection of three pleural tumors under the video-assisted thoracic surgery （VATS）. Histopathology confirmed these lesions to be pleural dissemination of type B1 thymoma. three years 2 months later, CT revealed a pleural tumor on the anterior chest wall. The tumor was resected under VATS and diagnosed as pleural dissemination of thymoma. Seven years 10 months after the last operation, the patient is alive without recurrence of thymoma nor symptoms of MG. It is important to follow up with CT after the operation of thymoma, and when pleural dissemination are suspected , VATS should be performed to achieve complete resection.