悪性腫瘍８

【臨床症状】50代　右背部痛　ホルネル症候群あり

【問題】画像所見と診断名は？

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    ▶答えはこちら
    • 右肺尖部の背側に病変あり
    • Dymanic像においてやや造影効果を認めるが、肋骨への浸潤（骨破壊）は認めない
    • 胸膜へ広く接しており浸潤が疑われる
    • 上記からPancorst腫瘍が疑われた
    • 縦隔などのリンパ節転移、また遠隔転移を示唆するような所見は認めない
    • 生検によってSCCが検出、Pancorst腫瘍と診断される
    ※ 縦隔条件の冠状断は非提示
    • その後、FDG-PET検査が実施され、肺尖部の腫瘍性病変に高集積を認めたが、遠隔転移は認めなかった
    PET-CT画像（非提示）

    【Pancoast腫瘍】

    ・肺癌が肺尖部の胸壁に浸潤した状態の事をPancoast症候群と呼ぶ

    ・Pancorst症候群は次のような症状を来し、これらは腕神経叢や傍脊椎交感神経幹、星状神経節への腫瘍の浸潤が原因

    • 上肢の尺側の疼痛
    • Horner症候群（縮瞳、眼瞼下垂、眼球陥凹を3大徴候とし、一側顔面の発刊低下も見られることもある）
    • 手の筋力低下と筋委縮

    ・Pancorst腫瘍は肺尖部から発生する原発性肺癌のみに用いられ、転移性の場合はPancorst腫瘍とは呼ばない

    ・扁平上皮癌が最も多く、腺癌などもある

    ・肩の疼痛が主な症状のため整形外科に受診する事が多く、発見まで時間がかかる事がある

    ・主な画像所見は次の通り

    • 肺尖部に腫瘤影を認め、肋骨や脊椎の骨破壊を伴う事もある
    • 初期の場合は胸膜肥厚と鑑別が難しい事がある
    • apical capが5mmを超える場合、または左右差が5mm以上の場合はPancorst腫瘍の可能性を考慮する
    参考書籍：困ったときの胸部の画像診断