家族内集積を示した多発性表面型腫瘍の1例 A Case Report of Many Flat Adenomas with Familial History of Colorectal Cancer

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症例は63歳,男性.大動脈弁閉鎖不全兼狭窄症にて弁置換術施行後,便潜血反応陽性を指摘され,大腸内視鏡を施行した.以来6年間の経過観察中に5個の早期癌,39個の腺腫が認められた.早期癌はすべてIIa型で,癌および腺腫の22.7%(10/44)は表面型腫瘍であり,これらの多くは右側大腸に分布していた.本症例は母親が73歳,妹は58歳で大腸癌で死亡しておりHNPCCの診断基準に合致し,さらにLynchらのflat adenoma syndromeの可能性も考えられた.1992年に肝弯曲部のII a型早期癌に対し,右半結腸切除術が施行された.深達度sm<SUB>1</SUB>の腺腫を伴う高分化型腺癌で,同病変の遺伝子学的検索ではK-ras codon 12の点突然変異は陰性,p53変異陽性,microsatellite instability陰性であった.家族内に大腸癌集積を示す表面型腫瘍多発症例においてもp53の異常が関与する可能性が考えられたが,マイクロサテライト領域の遺伝子不安定性についてはさらに症例数を増やしての検討が必要と考えられた.

A 63-year-old male underwent colonoscopy, because he was positive for immunological fecal occult blood after undergoing surgery for aortic insufficiency with stenosis.<BR>In the following 6 years, 5 early colonic carcinomas and 39 colonic adenomas were detected. All of the carcinomas were flat type (type IIa), 22.7% (10/44) of neoplastic lesions wer flat tumors, and 61.3% (27/44%) of them were arranged in the right-side colon.<BR>The patient's mother and sister died of colon cancer at the age of 73 and 58. So this family fit the criteria of HNPCC, and they may have had "flat adenoma syndrome".<BR>He underwent right-hemicolectomy because of IIa type early colon cancer in the hepatic flexure in 1992.<BR>DNA was extracted from this lesion, and the mutation of ras, p53, and microsatellite instability were investigated. The mutation of K-ras codon 12 and microsatellite instability were not detected, but mutation of p53 gene was detected in exon 8 by PCR-SSCP analysis.<BR>The result suggested that the carcinogenesis of flat adenomas with familial colorectal cancer history is the same as that without cancer history, and further examination is necessary to assess the microsatellite instability of flat carcinomas.

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 50(3), 177-182, 1997-03-01

    The Japan Society of Coloproctology

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