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━━ Background. Pleomorphic carcinoma is considered to be a histologic subset of lung cancer in the revised classification proposed by the WHO in 1999. Although treated as non-small cell lung cancer, the effects are usually limited and the prognosis is poor. On the other hand, metastasis of the palatine tonsils is very rare and considered to be a poor prognostic factor. We experienced a case of pleomorphic carcinoma with tonsillar metastasis that was very effectively treated with S-1 after chemoradiation therapy. Case. A 63-year-old male with an abnormal chest X-ray film shadow visited a general physician and was found to have a chest tumor that was diagnosed as non-small cell lung cancer on a needle biopsy. The patient was referred to our hospital where he underwent resection of the left upper lobe. A pathological examination revealed a histological tumor diagnosis of pleomorphic carcinoma, T2N0M0, stage IB. Tumor recurrence in the left tonsil occurred during uracil-tegafur (UFT) adjuvant chemotherapy, and we administered intravenous chemotherapy consisting of carboplatin and paclitaxel with concurrent radiotherapy; however, the treatment failed to shrink the tumor. Consequently, the patient received oral S-1 therapy, and the tumor disappeared seven months later. He has exhibited progression-free survival for four years and six months on S-1 therapy. Conclusions. In the present case, S-1 therapy achieved a longterm antitumor effect on chemoradiation-refractory pleomorphic carcinoma with tonsillar metastasis. Additional cases are needed to confirm the efficacy of S-1 in patients with pleomorphic carcinoma. (JJLC. 2013;53:771-777) KEY WORDS━━ Pleomorphic carcinoma, Tonsillar metastasis, S-1, Chemoradiation Reprints: Hajime Fujimoto, Department of Pulmonary Medicine, National Hospital Organization Mie Central Medical Center, 2158-5 Hisaimyojin-cho, Tsu-city, Mie 514-1101, Japan (e-mail: genfujimoto1974@yahoo.co.jp). Received February 18, 2013; accepted August 22, 2013. 要旨━━背景.多形癌は 1999 年のWHOによる肺癌の 組織学的再分類に伴い,新たに提唱された肺癌の組織型 の 1つである.通常非小細胞肺癌として治療されるが, 効果は乏しく,予後は不良とされている.一方,口蓋扁 桃への転移性腫瘍は非常に稀で,予後不良因子と考えら れている.我々は口蓋扁桃へ転移し,化学放射線治療後 に S-1 を投与したところ,著効した多形癌を経験したの で報告する.症例.63 歳男性.検診で左肺の異常陰影を 指摘され前医を受診,経皮針生検で非小細胞肺癌と診断 され,手術目的に当院へ紹介となった.左肺上葉切除術 を施行し,多形癌 pT2N0M0 stage IB と診断,術後補助化 学療法として uracil-tegafur(UFT)を処方していたが, 国立病院機構三重中央医療センター 1呼吸器科,2呼吸器外科; 3三重大学大学院医学系研究科病態制御医学講座呼吸器内科学. 別刷請求先:藤本 源,国立病院機構三重中央医療センター呼 吸器科,〒514-1101 三 重 県 津 市 久 居 明 神 町 2158-5(e-mail: genfujimoto1974@yahoo.co.jp). 受付日:2013 年 2 月 18 日,採択日:2013 年 8 月 22 日. (肺癌.2013;53:771-777) 2013 The Japan Lung Cancer Society Pleomorphic Carcinoma with Tonsillar Metastasis Successfully Treated with S-1―Fujimoto et al 772 Japanese Journal of Lung Cancer―Vol 53, No 6, Oct 20, 2013―www.haigan.gr.jp Figure 1. A chest radiograph revealed a mass shadow in the left upper lung field. Table 1. Laboratory Data on Admission Hematology Blood chemistry WBC 8390/μl Na 142 mEq/l RBC 459×104/μl K 4.0 mEq/l Hb 14.2 g/dl Cl 104 mEq/l Ht 43.1% BUN 11.1 mg/dl Plt 24.8×104/μl Cr 0.95 mg/dl AST 23 IU/l Serology ALT 23 IU/l CRP 0.33 mg/dl ALP 339 IU/l γ GTP 40 IU/l Tumor markers LDH 188 IU/l CEA 2.4 ng/ml T-Bil 0.5 mg/dl SLX 20.4 U/ml ChE 248 IU/l SCC 1.0 ng/ml TP 7.7 g/dl CYFRA 1.1 ng/ml Alb 4.3 g/dl NSE 10.9 ng/ml Glu 98 mg/dl 3 カ月で口蓋扁桃へ転移した.carboplatin+paclitaxel による化学療法および放射線治療を併用したが腫瘍縮小 効果は得られず,その後 S-1 を投与したところ 7カ月後 には転移巣は消失した.現在 S-1 開始後 4年 6カ月経過 しているが,無増悪生存中である.結論.口蓋扁桃へ転 移した多形癌に対し,化学放射線治療後に S-1 を投与し, 著効した症例を経験した.今後,多形癌に対する S-1 の有

A Case of Pleomorphic Carcinoma with Tonsillar Metastasis Successfully Treated with S-1 Following Chemoradiation Therapy