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━━ Background. Cases of malignant mesothelioma exiting or invading the posterior mediastinum are rare. Case. An 81-year-old male visited our hospital due to pain in the lower back. Plain chest computed tomography (CT) showed nodules in the right pleura and a vertebral mass invading the eleventh dorsal vertebra. We performed a thoracoscopic pleural biopsy, as the nodules in the right pleura were suspected to be pleural malignant lesions. The patient was consequently diagnosed with malignant pleural mesothelioma. In addition, the posterior mediastinal mass was suspected to be malignant lymphoma, and a bone marrow puncture showed a diagnosis of non-Hodgkin’s lymphoma. Although a biopsy of the posterior mediastinal mass was not performed due to the patient’s poor general condition, we administered antitumor drugs to treat the malignant mesothelioma. Hence, the patient was ultimately diagnosed with malignant mesothelioma based on a CT-guided percutaneous biopsy of the mediastinal mass. The posterior mediastinal mass was thought to be primary malignant mesothelioma, while the pleural nodules were considered metastases. No tumor progression was detected during one cycle of pemetrexed treatment followed by six cycles of combined carboplatin and pemetrexed therapy. Conclusions. Although it was difficult to differentiate the pleural nodules and posterior mediastinal mass from other posterior mediastinal tumors in this case, we ultimately diagnosed the lesions to be malignant pleural mesothelioma based on thoracoscopic pleural and CT-guided percutaneous biopsies. We reported this case because invasion of malignant mesothelioma into the posterior mediastinum is rare, and no previous reports of the coexistence of malignant mesothelioma and non-Hodgkin’s lymphoma are available. Therefore, the association between these entities is unclear. (JJLC. 2014;54:218-225) KEY WORDS━━Malignant pleural mesothelioma, Posterior mediastinal tumor, Non-Hodgkin’s lymphoma Reprints : Taro Yoneda, Department of Respiratory Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan (e-mail: taroyoneda@yahoo.co.jp). Received April 3, 2014; accepted July 1, 2014. 要旨━━背景.後縦隔腫瘍として,悪性中皮腫は稀であ る.症例.81 歳男性.腰痛を主訴に受診し,胸部単純CT にて右胸膜結節ならびに第 11 胸椎に椎体骨破壊像を伴 う後縦隔傍椎体腫瘍を認めた.胸膜結節に対して悪性胸 膜病変を疑い胸腔鏡下胸膜生検を行い,悪性胸膜中皮腫 と診断した.後縦隔腫瘍について病理診断は未施行で あったが,骨髄穿刺にて非ホジキンリンパ腫の骨髄浸潤 を認めたことから,後縦隔腫瘍は当初リンパ腫を疑った. 悪性胸膜中皮腫に対し抗癌剤治療,後縦隔腫瘍に対し放 射線治療を開始したが,放射線治療効果が乏しいことか ら治療途中に縦隔CTガイド下針生検を施行し,悪性中 皮腫の診断が得られた.以上より後縦隔部腫瘤原発の悪 1金沢大学附属病院呼吸器内科;2恵寿総合病院内科;3金沢医科 大学病理病態学. 別刷請求先:米田太郎,金沢大学附属病院呼吸器内科,〒9208641 石川県金沢市宝町 13-1(e-mail: taroyoneda@yahoo.co.jp). 受付日:2014 年 4 月 3 日,採択日:2014 年 7 月 1 日. (肺癌.2014;54:218-225) 2014 The Japan Lung Cancer Society A Case of Malignant Mesothelioma in Posterior Mediastinum―Yoneda et al Japanese Journal of Lung Cancer―Vol 54, No 4, Aug 20, 2014―www.haigan.gr.jp 219 Figure 1. Chest radiography performed on admission showing a nodule in the right peripheral lung. Table 1. Laboratory Data on Admission WBC 5400/μl IgG 2774 mg/dl RBC 413×104/μl IgA 73 mg/dl Hb 14 g/dl IgM 28 mg/dl Plt 15.2×104/μl CEA 2.4 ng/ml TP 8.1 g/dl CYFRA 6.3 ng/ml T-Bil 0.35 mg/dl ProGRP 41.0 pg/ml AST 15 U/l NSE 8.9 ng/ml ALT 20 U/l AFP 1.9 ng/ml LDH 164 U/l HCG <0.5 mU/ml BUN 17.4 U/l sIL-2 Receptor 606 U/ml Cr 0.7 mg/dl VMA (Urine) 2.59 mg/day Na 139 mEq/l K 3.8 mEq/l Cl 106 mEq/l CRP 0.4 mg/dl 性中皮腫が右胸膜に転移をきたした可能性が考えられ た.全身化学療法ならびに局所放射線療法を併用し,腫 瘍の増大なく経過している.結論.胸膜結節ならびに後 縦隔腫瘍に関して,他の後縦隔腫瘍との鑑別が困難で あったが,胸腔鏡下胸膜生検とCTガイド下縦隔生検に て診断し得た.後縦隔に悪性中皮腫が浸潤する症例は稀 であり,非ホジキンリンパ腫と悪性中皮腫の関連性は不 明であった. 索引用語━━悪性胸膜中皮腫,後縦隔腫瘍,非ホジキン

A Case of Malignant Pleural Mesothelioma That Was Difficult to Differentiate from Other Posterior Mediastinal Tumors