380 Table 中耳炎症状で発症した肺癌側頭骨転移の1例 1. Laboratory findings on admission. Fig.1. Chest X-ray film obtained on the first medical examination, showing a m

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1 Metastatic Tumor Presenting as Otitis Media in Primary Lung Cancer Key words: Temporal bone metastasis, Otitis media, Distant metastasis, Lung cancer

2 380 Table 中耳炎症状で発症した肺癌側頭骨転移の1例 1. Laboratory findings on admission. Fig.1. Chest X-ray film obtained on the first medical examination, showing a mass shadow in the left lower lung field. Fig.2. CT scan obtained on first medical examination, showing a mass shadow with spicule and pleural indentation in the left lower lobe. 5a),この異型細胞は肺腺癌手術時の中分化型腺 S8に辺縁不整で胸膜嵌入像を伴う腫瘤影を認めたが(Fig.2),平成5年7月の手術後,肺野異常陰影の出現や所属リンパ節腫脹は認めなかった. 側頭骨CTでは冠状断像で外耳道後壁を破壊し中耳腔へ進展する腫瘤を認め(Fig.3a),水平断像では左乳突洞内の気胞が消失し一部softdensity 癌の組織像と類似しており(Fig.5b),中耳の病 rnassに変は肺癌の遠隔転移と考えられた.背部痛につ置き換わっており側頭骨錐体部の一部に骨溶解像を伴っていた(Fig-3b).骨ムでは左顎関節付近と第8胸シンチグラ椎とに異常集積をいては胸椎X線で第8胸 osteoporosisまたは骨転移によるものと考えら認めた(Fig.4).腹部超音波検査では異常所見はれ,鎮認めず,頭部CTでは脳内への転移は認めなかっ検後,再た. 臨床経過:左聴に対して耳洗浄を続けるも症状改善しないため,中術を施行した.生痛剤投与により改善した.中耳内腫瘤の生検検組織標本で,上皮下組織内のリンパ管と骨内に異形細胞の増生が見られ(Fig. 現を認め,肺て両肺にびまん性の粟粒影の出内転移によるものと考えたため手術は不能と判断した.対症療法として耳洗浄を続けたが耳漏は軽減せず,難た.以耳内腫瘤生度他臓器の転移巣の有無を検索したところ,胸部CTに耳漏,難椎に圧迫骨折を認め. 聴も改善しなかっ後全身状態悪化し転院となった.

3 肺 381 癌:第37巻,3号1997年6月 Fig.3. CT scan of the temporal bone obtained on second admission, showing a tumor in the left middle ear on coronal section (a), and osteolytic change in the left temporal bone pyramid on horizotal section (b). b) a) Fig.4. Fig.5. Bone scintigraphy obtained on second admission, showing abnormal hot areas near the left temporo-mandibular joint and 8th thoracic vertebra. Photomicrograph of a biopsy specimen from the middle ear tumor, showing atypical cells (a), resembling to the moderately differentiated adenocarcinoma hyperplasia of of the lung (b).

4 1) Johnston AD: Pathology of metastatic tumors in bone. Clinical Orthopaedicus and Related Research 73: 8-32, ) Napoli AD, Hansen HH, Muggia FM, et al: The incidence of osseous involvement in lung cancer. Radiology 108: 17-21, 1973.

5 5) Schuknecht HF, Allam AF, Murakami Y: Pathology of secondary malignant tumors of the temporal bone. Ann Otol Rhinol Laryngol 77: 5-22, ) Hoshino T, Hiraide F, Nomura Y: Metastatic tumor of the inner ear. A histropathological report. J Laryngol Otol 86: , Metastatic Tumor Presenting as Otitis Media in Primary Lung Cancer Atsushi Kobayashi, Koichi Maeda, Keiichi Mikasa Takahiro Yoneda, Masayoshi Sawaki and Nobuhiro Narita Second Department of Internal Medicine, Nara Medical University A 67-year-old woman received a left lower lobectomy and dissection of regional lymphatics due to an adenocarcinoma of the lung (T2N1M0, Stage II) in July Nineteen months after surgery, she complained of left rhinorrhea and hearing loss. Temporal bone computed tomography revealed a tumor in the middle ear and osteolytic changes in the temporal bone pyramid. The histopathological findings of the tumor was adenocarcinoma, and it was diagnosed to be distant metastasis from lung cancer. Symptoms similar to otitis media were the main complaints in the case of distant metastasis from lung cancer.

Fig. 1. Chest X-ray film on admission showed a mass in the left middle lung field and multiple nodular densities in the bilateral lung fields. Fig. 3.

Fig. 1. Chest X-ray film on admission showed a mass in the left middle lung field and multiple nodular densities in the bilateral lung fields. Fig. 3. A Case of Slow-growing Mucous-producing Adenocarcioma of the Lung Key words: Mucous-producing lung adenocarcinoma, Slow-growing, Bronchial gland cell type adenocarcinoma, Adenoid cystic carcinoma Table

380 Table 中耳炎症状 で発症 した肺癌側 頭骨転移 の1例 1. Laboratory findings on admission. Fig.1. Chest X-ray film obtained on the first medical examination, showing a m

380 Table 中耳炎症状で発症した肺癌側頭骨転移の1例 1. Laboratory findings on admission. Fig.1. Chest X-ray film obtained on the first medical examination, showing a m