Missed Tumor with Chest Pain: Subtle Pleural Metastasis in Primary Adenocarcinoma of the Lung

胸部X光遺漏的病灶合併胸痛：原發性肺腺癌合併細微肋膜轉移

劉佳鑫(Chia-Hsin Liu) ； 簡志峯(Chih-Feng Chian) ； 彭萬誠(Wann-Cherng Perng) ； 蔡鎮良(Chen-Liang Tsai)

《胸腔醫學》 29卷2期 (2014/04) Pp. 100-104

摘要

原發性肺癌患者合併難以辨識肋膜轉移而無肋膜積液，可能會造成不準確的臨床分期，而進行傳統開胸手術。我們的案例報告是一個48歲的女性右下胸痛持續約1個月，而且一開始的胸部X光檢查是正常的。胸部電腦斷層顯示右下肺葉內側一個約2.2厘米鄰近肋膜肺結節，腫瘤穿刺結果為原發性肺腺癌。於患側合併有非典型細微肋膜增厚及不規則，且無肋膜積液。胸腔內視鏡輔助手術（VATS）顯示右側壁層及臟層肋膜呈現多發性結節，組織病理學檢查結果為低度分化的轉移性肺腺癌。

關鍵字

遺漏肺癌 ； 胸痛 ； 肋膜轉移 ； 肺腺癌

並列摘要

Subtle pleural metastasis without pleural effusion in patients with primary lung cancer may be misdiagnosed as operable, resulting in an inaccurate clinical staging. We report a case of a 48-year-old woman presenting with a 1-month history of right lower chest pain with an initial negative chest radiography finding. Chest CT showed a 2.2-cm nodule in the medial right lower lobe adherent to the adjacent pleura, with slight pleural thickness and irregularity but without pleural effusion. Transthoracic needle biopsy showed moderately differentiated primary pulmonary adenocarcinoma. Nevertheless, video-assisted thoracic surgery showed multiple nodules in the ipsilateral, parietal, and visceral pleura. Histopathology revealed the nodules were metastatic, poorly differentiated adenocarcinomas from the lung.

並列關鍵字

missed cancer ； chest pain ； pleural metastasis ； adenocarcinoma