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第62巻第5号目次 | Japanese/English |
 | Full Text of PDF (2351K) Article in Japanese |
─ 症例 ─
An Autopsy Case of Pleural Mesothelioma with Miliary Pulmonary Metastases
Yuko Asato1, Satoshi Hinata1, Kaoru Chiba1, Yusuke Ohnari1,2, Ken Okabayashi1, Hiromi Aono1, Kazuyoshi Marumo1, Yoshinori Kawabata3, Munehiro Yokoyama41Department of Internal Medicine, Respirology Division, Tokyo Metropolitan Police Hospital, Japan, 2Department of Internal Medicine, Saitama Jikei Hospital, Japan, 3Division of Diagnostic Pathology, Saitama Prefectural Respiratory and Cardiovascular Center, Japan, 4Department of Diagnostic Pathology, Tokyo Metropolitan Police Hospital, Japan
Background. Pleural mesothelioma is difficult to diagnose at an early stage and has a poor prognosis. This tumor may occasionally metastasize to other organs in the terminal stage. However, intrapulmonary miliary metastases are rare. We herein report a case of epithelioid pleural mesothelioma that presented with miliary metastases during chest imaging and an autopsy. Case. The patient was a 92-year-old woman without a history of asbestos exposure. The initial sign of mesothelioma was left pleural effusion. The patient lived for one year after the definitive diagnosis without specific treatment other than pleurodesis. Two months prior to death, chest radiography and computed tomography showed intrapulmonary miliary metastases. An autopsy confirmed this pattern of metastasis. The reason for the occurrence of miliary metastases remains unclear. However, the invasive characteristics of the tumor were speculated based on the histological and immunohistochemical findings. For example, a homozygous deletion of p16, which is related to a poor prognosis, was noted. In addition, the mesothelioma possessed micropapillary components, which indicated its aggressive characteristic. Thus, we speculated that these invasive characteristics contributed to hematogenous metastasis and lymphangitic spread and ultimately resulted in miliary metastases. Conclusion. We presented a case of epithelioid pleural mesothelioma with a rare metastatic pattern. We speculate that the pathogenesis of intrapulmonary miliary metastasis was related to the aggressive behavior, characterized by p16 deletion or micropapillary components.
索引用語：Epithelioid pleural mesothelioma, Miliary metastasis, Chest X-ray findings, p16 deletion, Micropapillary component
受付日：January 10, 2022
受理日：June 14, 2022
肺癌 62 (5)：411─416，2022
