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━━ Background. Pulmonary spindle cell carcinoma which consists of only spindle cells is quite a rare disease and it is associated with a poor prognosis due to its rapid progression and resistance to chemotherapy. Case. A 78-year-old woman was referred to our hospital because of an abnormal lung shadow on a chest X-ray obtained during a health examination. Chest computed tomography (CT) at the initial visit showed a mass measuring 45 mm in diameter in the S2 segment of the right lung, and lymph node enlargement of #2R, #7 and #11s was also observed. CT-guided lung biopsy revealed poorly-differentiated non-small-cell carcinoma of the lung, which was suspected to be pleomorphic carcinoma, and the patient was diagnosed to have cStage IIIA lung cancer. A follow-up CT at 1.5 months later showed the tumor growth to be 55 mm in diameter and polypoidal progression to the central side in the right upper lobe pulmonary vein was found. Since there is no chemotherapy that has been proven to be effective for the treatment of pleomorphic carcinoma, right upper lobectomy and node dissection ND2a-2 were performed. With the right superior pulmonary vein blocked in the pericardium, the right upper lobe pulmonary vein was transected. The extent of tumor progression was confirmed to be confined to within the vein, and its stump was closed by suturing. The tumor was pathologically diagnosed to be pulmonary spindle cell carcinoma, pStage IIIA. Postoperative adjuvant therapy was not performed because of the patient’s condition. Distant metastatic lesions in the inguinal and pelvic lymph nodes and soft tissue of the buttocks were detected 3 months after surgery, and the patient died of the disease 9 months after surgery. Conclusion. Pulmonary spindle cell carcinoma has the possibility of demonstrating a rapid recurrence, even if complete resection is performed. Further studies are therefore needed to fully identify the characteristics of pulmonary spindle cell carcinoma and improve the patient prognosis. (JJLC. 2015;55:1008-1013) KEY WORDS━━ Pulmonary spindle cell carcinoma, Pleomorphic carcinoma Received February 19, 2015; accepted July 26, 2015. 要旨━━背景.肺紡錘細胞癌は,紡錘形の腫瘍細胞から のみなるきわめて稀な癌腫で,急速な進行や化学療法抵 抗性などから,予後不良とされる.症例.症例は 78 歳女 性.検診異常で当院受診.初診時CTで右肺 S2に 45 mm 大腫瘤,右肺門および縦隔リンパ節腫大を認めた.CT ガイド下生検にて,低分化の非小細胞肺癌で,多形,肉 腫様癌が疑われ,cStage IIIA と診断した.初診時より 1.5 か月後の CTでは,腫瘍は 55 mm大へ増大し,上肺静脈 内を中枢側に進展していた.有効な化学療法も期待され ないため,右肺上葉切除,ND2a-2 郭清を施行した.肺静 脈については,心嚢内で右上肺静脈を遮断し,上葉肺静 脈を開いて腫瘍先端が同静脈内に留まることを確認した トヨタ記念病院 1呼吸器外科,2病理診断科,3呼吸器科. 受付日:2015 年 2 月 19 日,採択日:2015 年 7 月 26 日. (肺癌.2015;55:1008-1013) 2015 The Japan Lung Cancer Society A Case of Rapidly Progressive Pulmonary Spindle Cell Carcinoma―Yokota et al Japanese Journal of Lung Cancer―Vol 55, No 6, Oct 20, 2015―www.haigan.gr.jp 1009 後,断端を縫合閉鎖した.病理組織学的に,紡錘細胞癌, pStage IIIA と診断された.全身状態から経過観察のみ 行ったが,術後 3か月で右鼠径部や骨盤内リンパ節,臀 部の軟部組織に転移し,術後 9か月で癌死した.結論. 肺紡錘細胞癌は,完全切除症例でも術後早期に再発,転 移する可能性が高い.きわめて稀な腫瘍であり,症例報 告の集積,知見により集学的治療の成績改善が待たれる. 索引用語━━肺紡錘細胞癌,多形癌

A Case of Pulmonary Spindle Cell Carcinoma Showing a Rapid Progression into the Pulmonary Vein with Early Recurrence Following Complete Resection