肺の癌性リンパ管症の臨床病理学的検討 その発生と進展様式

• Material Type: 記事
• Title: 肺の癌性リンパ管症の臨床病理学的検討 その発生と進展様式
• Author Heading: 佐藤 隆; 松原 修; 春日 盂
• Publication Date: 1988
• Publication Date (W3CDTF): 1988
• Periodical title: 日本胸部疾患学会雑誌
• No. or year of volume/issue: 26 12
• Volume: 26
• Issue: 12
• Pages: 1243-1248
• Publication date of volume/issue (W3CDTF): 1988
• ISSN (Periodical Title): 03011542
• Publication (Periodical Title): The Japanese Respiratory Society
• Text Language Code: ja
• Subject Heading: Lymphangiosis carcinomatosa of the lung; Metastatic lung cancer; Pulmonary lymphatic vessels; Pulmonary fibrosis; 肺の癌性リンパ管症; 転移性肺癌; 肺リンパ管; 肺線維症
• Target Audience: 一般
• Standard No. (Other): COI : 1:STN:280:DyaL1M3lvFynsA%3D%3D; PMID : 3249492
• DOI: 10.11389/jjrs1963.26.12_1243; https://doi.org/10.11389/jjrs1963.26.12_1243
• Related Material (URI): https://search.jamas.or.jp/link/ui/1989216778
• Data Provider (Database): 国立情報学研究所 : CiNii Research; https://cir.nii.ac.jp/
• Original Data Provider (Database): Japan Link Center; https://japanlinkcenter.org/top; PubMed; https://pubmed.ncbi.nlm.nih.gov; CiNii Articles
• NAID: 130003449927

• Summary, etc.: Thirty-three autopsied cases with lymphangiosis carcinomatosa of the lung seen at our institution from 1977 through 1987 were reviewed. The patients, 18 men and 15 women, ranged in age from 29 to 86 years, and the mean age was 56 years. The mean duration from the onset of respiratory symptoms to death was 8 weeks. Direct causes of death were respiratory failure in 21 cases, cachexia (3 cases), hepatic failure (2), pericarditis carcinomatosa, metastases to the brain, massive hemorrhage and DIC (1).<br>The primary sites of carcinomas were the stomach in 19 cases, breast (3), prostate (2), esophagus, rectum colon, lung, bile duct, oral cavity, maxillary sinus and ureter (1). The histological types were adenocarcinoma in 28 cases, squamous cell carcinoma in 4 and transitional cell carcinoma in 1. Pleural effusion was noticed in 27 cases, tumor thrombi were seen in the blood vessels in 13 cases, and the distribution of lymphangiosis was predominant in the lower lobes in 13 cases. Diaphragmatic penetration of tumor cells was microscopically observed in 10 out of 13 cases examined. In areas where changes of lymphangiosis were prominent, alveolar walls showed fibrous thickening in 16 cases and edematous thickening (13), and alveolar ducts were accompanied by hyaline membrane (4).<br>Macroscopic and microscopic spreading patterns of lymphangiosis in lungs could be classified into four types; subpleural, hilo-bronchial, mixed and intrapulmonary types. The subpleural type in 12 cases showed a spreading pattern mainly in the pleura and subpleural region. The hilo-bronchial type in 4 cases showed a spreading pattern along bronchial trees from metastatic hilar lymph nodes. The mixed type in 15 cases had a spreading pattern of both subpleural and hilo-bronchial types. The intrapulmonary type in 2 cases had a pattern of intrapulmonary spread with neither hilar nodal metastasis nor pleural involvement.<br>The duration from the onset of respiratory symptoms to death was shorter in cases of the subpleural type than in those of the hilo-bronchial type. The ratio of respiratory failure in the causes of death was 80% of the cases of the mixed type, and occupied 50% of cases of other types. Pleural and subpleural lymphangiosis was prominent in the cases of subpleural and mixed types. Alveolar changes were more frequent in the cases of the mixed type than those of other types. The diaphragmatic penetration was more common in the subpleural (6 out of 7 cases; 86%) and mixed types (4 out of 4 cases; 100%) than in the hilo-bronchial and intrapulmonary types (0 out of 2 cases).; 肺の癌性リンパ管症33剖検例を臨床病理学的に検討した. 症例は男性18人, 女性15人で, 平均年齢は56歳であった. 呼吸器症状発症から死亡までの平均期間は8週間で, 直接死因は呼吸不全が21例と多く, 原発巣は胃が19例と多かった. 横隔膜を詳細に検索できた13例中の10例に, 腫瘍の横隔膜貫通所見を認めた. 癌性リンパ管症の強い部分には肺胞壁の線維性肥厚を16例に, 水腫性肥厚を13例に, 硝子膜形成を4例に認めた. 病理学的にリンパ管症の広がりを検討して見ると, 胸膜下型 (12例), 肺門気管支型 (4例), 混合型 (15例) と肺内型 (2例) の4型に分類できた. 胸膜下型の頻度の多いこと, 肺門気管支型の少ないこと, 横隔膜貫通例の多いことなどより, 肺の癌性リンパ管症の成立には肺門部リンパ管からの逆行性の進展よりも, 胸膜下型から混合型への進展がより重要であり, また, 胸膜および胸膜下へは経横隔膜的な経路が重要である可能性が示唆された.
• DOI: 10.11389/jjrs1963.26.12_1243
• Access Restrictions: インターネット公開
• Data Provider (Database): 科学技術振興機構 : J-STAGE; http://www.jstage.jst.go.jp