摘要
肺部多型性癌是一種罕見且具侵略性的惡性腫瘤，此腫瘤常發生於老年且具抽菸史之男性病患，臨床上以咳嗽、胸痛及咳血為主要臨床表現。。根據世界衛生組織在西元1999年的定義，多型性癌是由紡錘細胞及巨大細胞這兩種細胞再搭配其他較常見的上皮細胞組合而成。因其細胞型態之多樣性，術前病理診斷多型性癌有其困難性，免疫化學染色可給予診斷上的協助。較其他非小細胞肺癌，肺部多型性癌具有轉移性與復發性之特點。統計上，手術後在六個月內腫瘤常復發，而從復發至病人死亡約2.6個月。除了早期完整性手術切除外，目前並無證據顯示化療及放療對於此類腫瘤預後有臨床上顯著之助益。 我們在此報告一位50歲未曾吸煙的男性病人，因左胸痛及咳血1個月而至胸腔科門診求治。胸部電腦斷層檢查發現左下葉上節有一巨大周邊腫瘤併侵犯左上葉，經左肺全葉切除後，病理報告顯示為肺部多型性癌合併肺葉淋巴結轉移。病人沒有接受術後輔助性化學治療，於4個月後產生腦部轉移，雖經施行全腦放射治療，病人終於接受手術6個月後因肺炎併發敗血性休克而死亡。
並列摘要
Pulmonary pleomorphic carcinoma (spindle/giant cell) is a subset of sarcomatoid carcinoma. It is rare, and is seen predominantly in the sixth decade of life. The symptoms/signs and radiologic abnormalities are nonspecific. A large subpleural mass with areas of central low-attenuation is the most common finding in chest computed tomography. The pathologic diagnosis of pleomorphic carcinoma is difficult due to the heterogeneity of the tumor cells. Immunohistochemical examinations are helpful in making an appropriate diagnosis; the stains are positive for thyroid transcription factor-1, cytokeratins, and vimentin, and negative for surfactant protein-A. Pulmonary pleomorphic carcinoma has an extremely poor prognosis compared with other non-small cell lung cancers. The tumor usually relapses within 6 months after operation and median survival time after relapse is only 2.6 months. We reported the case of a 50-year-old lifelong non-smoking male with pulmonary pleomorphic carcinoma. The chest image showed a lobulated mass in the superior segment of the left lower lobe with invasion to the left upper lobe. Pneumonectomy of the left lung was performed and the diagnosis of pulmonary pleomorphic carcinoma with regional lymph node metastasis was made. The patient did not take chemotherapy after surgical resection. Brain metastasis occurred 4 months later. He died of pneumonia and septic shock 6 months after undergoing surgery.
延伸閱讀
- Suk, C. W., Yu, M. C., Liu, H. E., & Fang, C. L. (2011). 原發性肺絨毛膜癌併多重肺轉移－病例報告. 胸腔醫學, 26(5), 268-274. https://doi.org/10.29806/TM.201110.0004
- Tang, E. K., Chou, Y. P., & Hsu, H. K. (2004). 原發性肺臟惡性纖維組織細胞瘤：病例報告. 胸腔醫學, 19(3), 215-219. https://doi.org/10.29806/TM.200406.0007
- Chen, Y. T., Peng, M. J., Huang, W. C., & Chang, W. C. (2016). 原發性肺部惡性黑色瘤－病例報告. 胸腔醫學, 31(3), 176-181. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201606-201605240007-201605240007-176-181
- Tsai, J. R., Sheu, C. C., Hung, J. Y., Hsu, T. H., Tsai, K. B., & Huang, M. S. (2002). 非典型肺類癌合併多發性肺內轉移：病例報告與文獻回顧. 胸腔醫學, 17(2), 159-164. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-159-164-a
- Chen, H. H., Tsai, C. M., Perng, R. P., Chien, S. T., & Hsu, J. Y. (2008). 罕見的原發性肺部腫瘤：病例報告. 胸腔醫學, 23(1), 14-18. https://doi.org/10.29806/TM.200802.0003