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━━ Background. Pulmonary pleomorphic carcinoma (PPC) is a rare tumor of the lung and generally carries a poor prognosis. In addition, cases of PPC complicated by humoral hypercalcemia of malignancy (HHM) with an increased serum level of parathyroid hormone-related protein (PTHrP) produced by the tumor are rare. Case. A 59-year-old male smoker presented to us with a chief complaint of pain extending from the right shoulder to the back. Chest computed tomography (CT) showed an 11-cm mass shadow in the right apex area infiltrating the chest wall and an enlarged left adrenal gland. A CT-guided biopsy showed poorly differentiated tumor cells with sarcomatous changes, which led to the diagnosis of PPC (cT4N0M1b, clinical stage IV, ADR). When admitted for treatment, the patient developed mild consciousness disturbance and was found to have an increased serum level of PTHrP and hypercalcemia; based on these findings, the patient was diagnosed with HHM. He was administered an intravenous infusion of zoledronic acid in saline to control the hypercalcemia. After the serum calcium levels normalized, he was administered six courses of carboplatin+paclitaxel+bevacizumab combination chemotherapy. The chemotherapy proved effective. Conclusion. Although chemotherapy is known to have poor efficacy in patients with advanced PPC, three-drug combination therapy including bevacizumab proved useful in our patient. (JJLC. 2017;57:221-225) KEY WORDS━━ Pulmonay pleomorphic carcinoma, Hypercalcemia, PTHrP Corresponding author: Hideharu Kimura. Received November 4, 2016; accepted April 10, 2017. 要旨━━背景.肺多形癌は稀な肺腫瘍であり,一般的に 予後不良である.副甲状腺ホルモン関連蛋白(parathyroid hormone-related protein;PTHrP)の上昇に伴う高 Ca血症(humoral hypercalcemia of malignancy;HHM) を合併した肺多形癌の報告は稀である.症例.59 歳の現 喫煙男性.右肩から背部にかけての疼痛を訴え受診した. 胸部CTにて右上葉に胸壁に浸潤する 11 cm大の腫瘤 影と左副腎腫大を指摘された.CTガイド下生検で肉腫 様変化を伴う分化度の低い腫瘍細胞を認め,肺多形癌 (cT4N0M1b,臨床病期 IV期,ADR)と診断した.入院 時に軽度の意識障害を認め,PTHrP の上昇とそれに伴う 高Ca血症を認めたためHHMと診断した.ゾレドロン 酸と生理食塩液の点滴を行い血清Ca値が正常化したこ とを確認した後に,カルボプラチン,パクリタキセル, ベバシズマブによる 3剤併用化学療法を 6コース施行 し,奏効を得た.結論.進行期肺多形癌は化学療法の効 果に乏しいことが知られているが,このベバシズマブを 含む 3剤併用療法が有用である可能性が示唆された. 索引用語━━肺多形癌,高Ca血症,PTHrP 1金沢大学附属病院呼吸器内科. 論文責任者:木村英晴. 受付日:2016 年 11 月 4 日,採択日:2017 年 4 月 10 日. (肺癌.2017;57:221-225) 2017 The Japan Lung Cancer Society Pulmonary Pleomorphic Carcinoma Associated with Humoral Hypercalcemia of Malignancy―Ogawa et al 222 Japanese Journal of Lung Cancer―Vol 57, No 3, Jun 20, 2017―www.haigan.gr.jp Figure 1. The tumor cells consisted of spindle cells with necrotic and fibrotic changes (hematoxylin-eosin staining, 200×). はじめに 肺多形癌は稀な肺腫瘍であり,一般的に予後不良であ る.また,腫瘍性に産生された副甲状腺ホルモン関連蛋 白(parathyroid hormone-related protein;PTHrP)の上 昇に伴う高Ca血症(humoral hypercalcemia of malignancy;HHM)を合併した肺多形癌は稀である.今回, 我々はカルボプラチン,パクリタキセル,ベバシズマブ 併用療法が奏効したHHM合併肺多形癌の 1例を経験し た.近年,肺多形癌に対してベバシズマブ併用療法が奏 効した報告例が散見されており,文献的考察を含めて報 告する.

haigan

A Case of Pulmonary Pleomorphic Carcinoma Associated with Humoral Hypercalcemia of Malignancy Successfully Treated with Carboplatin+Paclitaxel+Bevacizumab Combination Therapy