- 期刊
High-Grade Bronchial Mucoepidermoid Carcinoma: A Case Report
高度惡性支氣管黏液類上皮癌：病例報告
摘要
支氣管黏液類上皮癌為一種罕見之肺腫瘤，約佔原發性肺癌的0.1%至0.2%。組織學上，可見黏液細胞、鱗狀細胞及中間型細胞同時存在，依其表現可區分為低度惡性（low-grade）和高度惡性（high-grade）腫瘤。它可在任何年齡發生。患者之臨床症狀通常與氣道之刺激及阻塞有關，如咳嗽、咳血、喘鳴或呼吸困難。治療及預後則視組織學上之分級和臨床之分期而有所不同。雖然此腫瘤大多具有良性的臨床病程，但其中20%-25%屬高度惡性腫瘤，其臨床表現亦較為惡性。 一位44歲的女性病患，於左下肺葉支氣管發生黏液類上皮癌，併有皮膚、乳房及脊椎等多處轉移。患者在因皮膚及乳房結節求診前已經咳嗽近半年，而皮膚結節之病理切片報告為轉移癌。胸部Ｘ光檢查發現在近左肺門處有一肺腫塊。支氣管鏡檢查則發現在左下肺葉前支有一氣道內腫瘤，切片病理報告証實為黏液類上皮癌。雖經積極之化學治療及放射治療，病情仍急速惡化，患者於診斷後75天死亡。此種罕見的原發性肺癌，臨床症狀並無特異性；但經由影像學及支氣管鏡檢查，很容易發現腫瘤的存在，加上組織學表現有其特色，診斷並不困難。低度惡性腫瘤可以外科手術切除治癒，高度惡性腫瘤之癒後不一。本例即為一具高度侵犯性，併多處轉移之病例，其治療方式仍需多方探討。
並列摘要
Bronchial mucoepidermoid carcinoma is a rare lung tumor comprising only 0.1%-0.2% of all primary lung cancers. Histologically, this neoplasm is characterized by the coexistence of mucus-secreting cells, squamous cells, and cells of an intermediate type. It can be found in all age groups, usually presenting with symptoms associated with airway irritation or obstruction, such as cough, hemoptysis, dyspnea, or wheezing. The treatments and outcomes vary depending on the histological grades and the clinical stages. We herein report a case of high-grade bronchial mucoepidermoid carcinoma in a 38-year-old woman with skin, breast and spine metastases. The patient presented with four cutaneous nodules and one in the right breast. She had dry cough for 6 months, which, however, was ignored. An excisional biopsy of one of the cutaneous nodules was reported as metastatic carcinoma. Chest radiography revealed a central lung mass. Bronchoscopy found an endobronchial tumor in the anterobasal segmental bronchus of the left lower lobe. The bronchoscopic biopsy proved the diagnosis of mucoepidermoid carcinoma. Despite aggressive chemotherapy and radiotherapy, the disease progressed rapidly with spinal metastasis and bronchial obstruction. The patient died 75 days after diagnosis.