Dramatic Improvement of Severe Bronchorrhea after Gefitnib Treatment in a Patient with Possible Bronchioloalveolar Carcinoma

Gefitinib顯著改善大量支氣管漏於疑似肺泡細胞癌病人

林世章(Shih-Chang Lin) ； 何肇基(Chao-Chi Ho) ； 余忠仁(Chong-Jen Yu) ； 楊泮池(Pan-Chyr Yang)

《胸腔醫學》 21卷1期 (2006/02) Pp. 82-88

https://doi.org/10.29806/TM.200602.0013

摘要

支氣管漏(bronchorrhea)的表現在肺泡細胞癌(bronchioalveolar carcinoma)病患身上並不算少見，然而肺泡細胞癌的確定診斷常常需要開胸手術。因為不論是經支氣管鏡或經皮超音波指引切片其敏感度依不同研究差異甚大（14％到80%）。事實上，藉由痰液中上升之腫瘤指標，如胚胎癌抗原(carcinoembryonic antigen, CEA)及癌抗原19-9(cancer-associated antigen 19-9, CA19-9)也可以提供診斷之參考。我們在這個報告中提出一個罕見的病例是以大量水狀的支氣管漏及胸部X光多肺葉實質病變來表現並快速進展成嚴重的缺氧性呼吸衰竭。對病人投以急性呼吸窘迫症(acute respiratory distress syndrome, ARDS)的標準治療對於改善低血氣並無明顯幫助。我們稍後在痰液中偵測到非常高濃度的胚胎癌抗原及癌抗原。而在給予口服抗癌藥物gefitinib之後，每日的痰量迅速降低（由六百四十降至兩百毫升）。除此之外，病人的血氧濃度和X光的實質病變也都得到明顯的改善。因此我們認為在治療肺泡細胞癌造成的嚴重支氣管漏時，可以考慮使用gefitinib。

關鍵字

支氣管漏 ； 肺泡細胞癌 ； gefitinib ； 胚胎癌抗原 ； 癌抗原19-9

並列摘要

Bronchorrhea is not uncommon in patients with bronchioloalveolar carcinoma (BAC). Confirmation of the diagnosis of BAC often requires thoracotomy, because the diagnostic sensitivity of fiberoptic bronchoscopy and needle aspiration varies very widely (14% to 80%). Elevation of carcinoembryonic antigen (CEA) and cancer-associated antigen 19-9 (CA19-9) in the sputum is another way to suggest the possibility of BAC. Herein, we report an unusual case with profuse watery sputum and multilobar consolidation on the chest radiography. Severe hypoxic respiratory failure, which was refractory to conventional treatment for acute respiratory distress syndrome (ARDS), developed after admission. The sputum contained very high levels of CEA and CA19-9 (146.1ng/ml and 77,873.0U/ml, respectively), in spite of a nearly normal serum level. After treatment with gefitinib, the daily volume of sputum dramatically decreased, from 640ml to 200ml. The reduction in the sputum volume was associated with alleviation of the hypoxia and partial resolution of the consolidation. This case suggests the value of gefitinib in the treatment of severe bronchorrhea caused by malignancy.

並列關鍵字

bronchioloalveolar carcinoma ； bronchorrhea ； gefitinib ； carcinoembryonic antigen CEA ； cancer-associated antigen 19-9 CA19-9