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Vol.41 No.2 contents | Japanese/English |
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- Case Report -
An Experience With Surgical Treatment of Lung Cancer Associated With Idiopathic Thrombocytopenic Purpura (ITP)
Kase Masahiro, Yamagata Tatsusi, Watanabe Kosirou*, Kunikane Hirosi*, Okamoto Hiroaki* and Nagatomo Akira*Department of Thoracic Surgery and Department of Respiratory Diseases*, Yokohama Municipal Citizens Hospital
Case: A 75-year-old man was hospitalized with bloody sputum. Chest X-ray film and CT scanning images detected a mass in the right upper lobe (S2) of the lung. Diagnosis could not be bronchoscopically confirmed and video-assisted thoracic surgery (VATS) was planned. The preoperative platelet count was as low as 4.6×104/mm3, suggesting idiopathic thrombocytopenic purpura (ITP). Because PAIgG was elevated to 267.7 ng/107 cells and images of the aspirated bone marrow, the patient was eventually diagnosed as having ITP, and underwent preoperative high-dose intravenous immunoglobulin (HIVG) therapy. However, the platelet count only slightly increased 5 days later with hemorrhagic tendency, and therefore, the VATS was postponed. Investigations for all underlying autoimmune diseases causing the ITP were negative. During the test period, the platelet count remained at 7×104/mm3 but the hemorrhagic tendency improved. On day 21 after the HIVG therapy, VATS and right upper lobe lobectomy with complete mediastinal dissection were successfully carried out in combination with platelet transfusion. The histological diagnosis was large cell carcinoma, and the pathological stage was IIIA (T1N2M0). Conclusion: HIVG therapy is very useful for surgical operation of ITP-complicated lung cancer. However, the careful observation of the clinical findings are required to decide timely implementation of the surgery, and platelet transfusion may be required when the platelet count is not sufficiently increased.
key words: Idiopathic thrombocytopenic purpura (ITP), Lung cancer, High dose intravenous gammaglobulin therapy, Lung resection, Platelet transfusion
Received: November 22, 2000
Accepted: February 15, 2001
JJLC 41 (2): 157-160, 2001
