Nakajima Masamitsu; Tamada Sadao; Yoshida Kouichirou; Sugihara Satoru; Okimoto Nirou; Niki Yoshito; Manabe Toshiaki; Soejima Rinzo
日胸疾会誌 The Japanese Respiratory Society 32 (11) 1109 - 1114 0301-1542 1994
[Refereed] We report a case of pulmonary alveolar proteinosis (PAP) in which the serum levels of CEA, CA15-3, and TPA, as well as the whole lung lavage fluid levels of CEA, CA19-9, CA125, CA15-3, CA50, SLX, SCC, and TPA were high. The patient was a 39-year-old man who presented with exertional dyspnea, and nonsegmental bilateral reticular infiltration shadows in the middle and lower lung fields on the chest radiograph. A diagnosis of proteinosis was confirmed by histopathology of the transbronchial lung biopsy (TBLB) specimen, biochemical analysis of the phospholipids, and an electron microscopic study of lavage fluid. Whole lung lavages alleviated his symptoms, effaced the shadows on the chest radiograph and brought the blood gas values closer to normal. An immunohistochemical study of TBLB specimens showed that CEA, CA153, and SLX were positively stained in the alveolar epithelia. With repeated lavage, tumor markers (CEA, CA15-3, TPA) in the fluid decreased. These results suggest that the alveolar epithelia indeed produced these tumor marker molecules. In PAP, it is well recognized that CEA may be high in at least one of the following: serum, bronchoalvelolar lavage fluid, and whole lung lavage fluid. To date, however, the site of production of such tumor markers had not been clearly demonstrated to be in the lung tissue. This case is interesting because there are few reports of PAP with high levels of tumor markers in the serum and whole lung lavage fluid, and because the tumor markers found in abnormally high amounts in this patient were produced by alveolar epithelia.
症例は39歳, 男性. 労作時呼吸困難, 胸部X線上異常陰影にて当科に紹介入院となった. 入院後経気管支肺生検にて肺胞蛋白症と診断し, 現在までに2回の全身麻酔下左肺洗浄を施行し, 軽快退院している. 今回再度肺胞蛋白症の増悪がみられたため入院となった. 血清中のCEAが高値であったため他の腫瘍マーカーの測定を行い, 血清中のCA153, TPAの高値を認めた. さらに肺洗浄液中の腫瘍マーカーの測定を行い, CEA, CA19-9, CA125, CA15-3, CA50, SLX, SCC, TPAが血清正常値以上を示した. 血清中高値の腫瘍マーカー全て肺洗浄後減少傾向を示した. そこで, 高値を示した腫瘍マーカーの産生部位を検索する目的で経気管支肺生検組織の免疫染色を行った. 肺胞上皮にCEA, CA15-3, SLXが陽性を示し, これらはII型肺胞上皮を含む肺胞上皮より産生されていることが示唆された. 本症の肺洗浄液中でCEAが高値を示すことは知られているが, その他の腫瘍マーカーについての検討は少なく興味ある症例と考えられた.