@article{oai:kanazawa-u.repo.nii.ac.jp:00014259,
 author = {金子, 勇貴 and 松本, 勲 and 高田, 宗尚 and 田村, 昌也 and 齋藤, 大輔 and 竹村, 博文},
 issue = {3},
 journal = {肺癌 = Haigan},
 month = {Jul},
 note = {Background. In cases of lung cancer accompanied by multiple pulmonary nodules, it is important to determine whether or not the nodules are intrapulmonary metastasis from the primary tumor. Pulmonary angiomyolipoma (AML) is a rare disease that is occasionally accompanied by lymphangiomyomatosis (LAM), which sometimes exhibits pulmonary nodules. Case. The patient was a 65-year-old woman who had undergone right nephrectomy due to a renal AML rupture at the age of 33. A pulmonary nodule was observed in the mid-lung field on a chest X-ray at the age of 65. Chest computed tomography (CT) revealed an irregularly-shaped nodule with a maximum diameter of 1.9 cm in the lingula of the left lung as well as bilateral multiple small nodules with a homogeneous fat density and cysts. Fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated FDG accumulation in the nodule in the lingula but not in the other nodules. The CT attenuation values of the multiple small nodules were consistent with the value of fat. These results, as well as patient's history of renal AML, suggested primary lung cancer accompanied by pulmonary AML. Surgery was performed. After partial resection, the multiple small nodules were diagnosed, based on the intraoperative examination of frozen sections, as lipomas and the single nodule in the lingula was diagnosed as an adenocarcinoma. A left upper lobectomy with lymph node dissection (ND2a-1) was performed. A pathological examination revealed stage IA pulmonary adenocarcinoma (T1aN0M0). In addition, an immunohistochemical analysis revealed estrogen receptor (ER), α-smooth muscle actin and Melan-A positivity. The multiple small nodules were therefore diagnosed as AML, while the cystic lesions were diagnosed as LAM. Conclusion. We report a very rare case of lung cancer coexisting with pulmonary AML and LAM. A precise diagnosis is important in cases where lung cancer is accompanied by multiple pulmonary nodules, in order to distinguish the primary lung tumor from pulmonary metastasis. In our case, the CT attenuation values and FDG-PET were useful for the differential diagnosis. 背景．肺癌に多発肺結節を伴う場合，肺転移かどうかの診断が重要である．また肺血管筋脂肪腫（AML）はリンパ脈管筋腫症（LAM）を合併する稀な疾患であり，ときに多発肺結節を呈する．症例．65歳，女性．33歳時に腎AML破裂のため右腎摘出術歴あり．65歳時に検診の胸部X線写真で左中肺野に結節影を指摘された．胸部CTでは左肺舌区に1.9 cm大の辺縁不整な結節影と，多発する脂肪濃度の肺結節，肺嚢胞を認め，FDG-PETでは舌区の結節にのみFDG集積があった．多発肺結節に関しては既往歴，CT値，FDG集積のないことから肺AMLを疑い，原発性肺癌と肺AMLの合併として手術を施行．肺部分切除後，術中迅速診断にて多発肺結節は脂肪腫，舌区の結節は腺癌と診断され，左肺上葉切除術および2a-1群リンパ節郭清を行った．最終病理診断はpT1aN0M0，IA期肺腺癌であり，他病変はエストロゲン受容体，α平滑筋アクチン，Melan-Aが陽性で，多発肺結節はAML，嚢胞性病変はLAMと診断された．結論．肺癌に肺AML，肺LAMを合併した極めて稀な症例を経験した．肺転移との鑑別にCT値，FDG-PET検査が有用であった．, Embargo Period 24 months},
 pages = {210--214},
 title = {肺血管筋脂肪腫と肺リンパ脈管筋腫症を合併した肺腺癌の1切除例},
 volume = {56},
 year = {2016}
}