 |
Vol.49 No.2 contents | Japanese/English |
 | Full Text of PDF (872K) Article in Japanese |
- Case Report -
A Case Report of Lung Cancer After Remission of Pulmonary Alveolar Proteinosis
Junzo Ishida1, Kinya Furukawa1, Gaku Yamaguchi1, Makoto Saito11Department of Thoracic Surgery, Tokyo Medical University Kasumigaura Hospital, Japan
Background. Pulmonary alveolar proteinosis (PAP) is a rare disease, and there have been few reports of PAP associated with lung cancer. We encountered a patient with lung cancer who had been diagnosed PAP many years age. Case. An abnormal shadow was found in the chest roentgenogram of a 66 year-old man, who visited to our hospital. His chest X-ray film showed diffuse ground-glass or granular shadows bilaterally in the lung fields. Transbronchial lung biopsy (TBLB) was performed, and the lesions were diagnosed as PAP. He had no symptom, therefore he was followed up. After one year, he had shortness of breath and visited his home doctor. He was referred to our hospital because of hypoxemia. In the intensive care unit, we performed therapeutic bronchoalveolar lavage fluid (BALF) under general anesthesia, and thereafter repeated therapeutic BALF under local anesthesia was performed after tracheotomy. As a result, PAP was found to be in remission. Since then, he required hospitalization more than once because of hemoptysis caused by lung aspergillosis. He had been in remission for some time with antifungal agent therapy. However, hemoptysis recurred after 5.5 years, and he was admitted to our hospital. CT scan showed a lesion with a cavity in the left S3 and a consolidation 40 mm in diameter in the left S9, which was suspicious of lung cancer. The result of careful examination showed the lesion as a non-small cell lung cancer (T3N0M0, clinical stage IIB). We performed left lower lobectomy and lymph node dissection (ND2a) with partial resections of diaphragm and left upper lobe (aspergilloma). Conclusion. Dysfunction of alveolar macrophages can be recognized in many lung cancer patients. Patients with PAP may be a group at high-risk for lung cancer, and careful long-term follow up study is required in those patients after remission of PAP.
key words: Pulmonary alveolar proteinosis, Lung cancer, Alveolar macrophage, Granulocyte macrophage-colony stimulating factor
Received: September 1, 2008
Accepted: November 17, 2008
JJLC 49 (2): 193-197, 2009
