直腸内分泌細胞癌の1例 A CASE OF ENDOCRINE CELL CARCINOMA OF THE RECTUM

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症例は78歳,男性.平成13年5月5日から全身倦怠感,食欲不振が出現し下血を認めたため当院内科を受診した.カルチノイド症状は認めなかった.大腸内視鏡検査で下部直腸に1型腫瘍を認め,生検で低分化腺癌もしくは未分化癌と診断された.腹部CT検査で多発肝転移を認めた.腹会陰式直腸切断術とリザーバー留置術を行った.免疫組織染色のクロモグラニンA, NSEで陽性像を示し,内分泌細胞癌と診断された.化学療法を開始したが,平成14年1月5日死亡した.内分泌細胞癌は予後不良であり,低分化腺癌や未分化癌との鑑別が困難である.直腸内分泌細胞癌の本邦報告例は自験例を加えて37例であり,術前から肝転移を認めた症例は22例であった.早期癌の症例は5例あるがいずれも予後は不良であり壁深達度と予後の関連はないと考えられた.内分泌細胞癌は外科的切除が第一選択と考えられるが,予後は不良で何らかの補助療法が必要である.

A 78-year-old man was seen at the hospital because of general fatigue, appetite loss and anal bleeding. Colonoscopic examination showed a type 1 tumor in the lower rectum and the histological diagnosis from a biopsy specimen was poorly or undifferentiated adenocarcinoma. Multiple liver metastases were discovered by abdominal computed tomography (CT). Abdomino-perineal amputation of the rectum and reservoir implantation were performed. Immunohistochemically the resected specimen was positive for chromograine A and NSE stain. The definite diagnosis was endocrine cell carcinoma. Chemotherapy was started but the patient died 6 months after the surgery.<br>Endocrine cell carcinoma has malignant potential and discrimination from poorly or undifferentiated adenocarcinoma is difficult. In a review of the Japanese literature 37 cases of neuroendorine tumors of the rectum have been reported. Of the 37 cases, liver metastasis was confirmed in 22 cases before surgery. Five cases were early carcinoma but the prognosis of them was poor. It is thought that the prognosis is not related to infiltration depth. Endocrine cell carcinoma has a very poor prognosis and effective multimodal therapy including operation and chemoradiotherapy should be established.

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  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 65(3), 751-755, 2004-03-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10012865421
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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