Synchronous Double Primary Malignancy: Adenocarcinoma of Lung and High-Grade Brain Malignancy, Anaplastic Oligoastrocytoma

同時發生的二處惡性腫瘤：肺腺癌和腦部的分化不良型寡樹突星狀膠質細胞瘤

林永淵(Yung-Yuan Lin) ； 林慶雄(Ching-Hsiung Lin) ； 葉金水(Chin-Shui Yeh) ； 張竣期(Chun-Chi Chang) ； 施穎銘(Ying-Ming Shih) ； 何上芸(Shang-Yun Ho) ； 陳威良(Wei-Liang Chen) ； 鄧宗翰(Tsung-Han Teng)

《胸腔醫學》 24卷1期 (2009/02) Pp. 42-48

https://doi.org/10.29806/TM.200902.0006

摘要

同時在腦部及肺部發現原發惡性腫瘤是非常少見的，文獻中只有2個病例報告。由於病例稀少，當一個病人被診斷肺癌，而腦部又發現有另一個腫瘤的話，大部分的病人會被當成肺癌併腦轉移。
我們報告一個76歲女性，她因為講話含糊不清持續二週而到我們的醫院就診。腦部核磁共振檢查發現左邊頂葉有一個腫瘤，腫瘤周圍並有水腫。接著安排病人接受立體定位切片，病理診斷為分化不良型寡樹突星狀膠質細胞瘤(anaplastic oligoastrocytoma)。同一時間，手術前的例行性胸部X光片檢查意外發現在左肺門區域有一個濃度增加的病灶，胸部斷層掃瞄顯示是一個腫瘤在左肺舌葉。支氣管鏡檢查並無異常發現，而斷層掃瞄導引下切片證實了是肺腺癌。由於患者年紀較大及活動力差，家屬拒絕手術及化學治療，病人僅接受緩解症狀的腦部放射治療，病人目前已存活超過7個月。
這個病例提醒我們，去尋找並診斷和肺癌同時發生的另一個惡性腫瘤是很重要的；因為這二個腫瘤都有可能治癒，而病人可能獲得長時間的存活。

關鍵字

同時發生的二處原發惡性腫瘤

並列摘要

Synchronous double primary malignancy of the lung and brain is extremely rare, as there were only 2 cases reported in the literature. If patients were found to have both lung and brain malignancy, they would be ordinarily be considered to have lung cancer with brain metastasis.
We report a 76-year-old female who came to our hospital due to slurred speech for 2 weeks. Brain magnetic resonance imaging (MRI) showed a heterogeneous mass lesion at the left parietal lobe with perifocal edema. Stereotactic biopsy confirmed anaplastic oligoastrocytoma. In the meantime, the pre-operative chest radiograph accidentally found a patch of opacity at the left hilar area during the same admission. The chest computed tomography (CT) scan showed a mass lesion at the left lingular lobe; bronchoscopic finding was unremarkable. Histology of the CT-guided biopsy specimen showed adenocarcinoma. Due to the poor performance status and the patient's family refusing operation, only palliative radiotherapy to the brain was administered. She was still living 7 months later.
This case report highlights the importance of searching for and confirming synchronous tumor in addition to lung cancer, since there is the potential of cure and long-term survival.

並列關鍵字

synchronous double primary malignancy