突然変異の多型性が確認された同時性多発直腸癌の1例 A Case of Synchronous Quintuple Rectal Cancer with Mutational Polymorphism

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直腸内で同時性に1個の進行癌と4個の早期癌を発生した症例を経験した.症例は53歳の女性.便潜血陽性の精査により,Rbに2型直腸癌,RsからRaに0-Is型の4個の早期癌を認めた.またS状結腸からRbにかけて16個の腺腫も認めた.肝転移はなく,上方D3,側方D1リンパ節郭清の直腸切断術を行った.組織学的診断ではRbの病変が高分化腺癌で深達度はa1,早期癌の深達度はすべてm,腺腫は軽度から中等度異型を伴っていた.リンパ節転移は認めなかった.粘膜下の連続性はそれぞれ認められず,それぞれが独立した病変と考えられた.免疫組織染色とPCR-SSCP法を用いてp53遺伝子の突然変異を検討したところ,.それぞれの病変で変異部位が異なり,本症例の多発した病変の起源が多中心性発癌であることが推測された.

An advanced lower rectal cancer and four early rectal cancers were detected in a 53-year-old woman. Rectal amputation was performed, and histological examination showed an advanced lesion that had invaded adventitia, and other cancers limited to the mucosa. Sixteen tubular adenomas, with mild to moderate atypia, were also detected in the resected specimen. No other lesions were found in the rest of the colon. All of the lesions were histologically independent ; however, there is no difference among these-well differentiated adenocarcinomas, except for their depth of invasion.<BR>Immuno-histochemistry and polymerase chain reaction single strand comformational polymorphism (PCR-SSCP) revealed the difference of the point of mutation in p53 gene among the cancers. In conclusion, the carcinogenic multiplicity of this case originated from multicentric carcinogenesis with various mutational changes.

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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 56(4), 161-165, 2003-04-01

    The Japan Society of Coloproctology

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