脳転移をきたした直腸内分泌細胞癌の1例 [in Japanese] A Case of Rectal Neuroendocrine Carcinoma Metastatic to the Brain [in Japanese]
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症例は53歳の男性で, 便秘を主訴に来院. 大腸内視鏡検査で直腸に2型の腫瘍を認め生検にて低分化腺癌と診断され, 低位前方切除術 (D2郭清) を施行された. 組織学的に悪性度の高いカルチノイド腫瘍で, INFb, ss, ly2, v0, n1 (+), stage IIIaであった. 2年5カ月後に局所再発のため, 腫瘤切除術を施行された. 再発組織には核分裂像が多数認められ, Ki-67陽性細胞率68%であり, 内分泌細胞癌と診断された. 化学療法 (CDDP+UFT) を施行するも腫瘍は骨盤内にて増大し, 再手術1年5カ月後に, 再々手術が施行されたが, その5カ月後, 局所再発, リンパ節転移, 脳転移にて原癌死した. 内分泌細胞腫瘍は, 腫瘍細胞の異型度により臨床像に違いが見られるが, 脳転移をきたした内分泌細胞癌を経験したので考察を加え報告する.
A 53-year-old man was admitted because of constipation and was diagnosed by endoscopy and a biopsy as having poorly differentiated adenocarcinoma of the rectum. A low-anterior resection was performed. Pathological examination of the rectal tumor showed INFb ; ss ; ly2 ; v0 ; and n1 (+), stage IIIa ; and it was diagnosed as a malignant carcinoid. Twenty-nine months after the first operation, the tumor recurred, and a second resection operation was performed. A histological examination showed a highly increased mitotic rate and a high proliferation index (68%, Ki-67 positive cells). It was considered that the histologic appearance of the primary rectum and the metastatic tumor suggested neuroendocrine carcinoma, and the working diagnosis was histologically reinterpreted. After the second operation, the patient received CDDP and UFT chemotherapy. Seventeen months after the second operation, the tumor recurred in the pelvis. A third resection operation was performed, but five months after this operation, the tumor progressed, spread to the lymph nodes and brain, and the patient died. Neuroendocrine tumors are heterogeneous and potentially aggressive and can be distinguished from other tumors because their growth and cytologic features are typical. A case of brain metastasis from neuroendocrine carcinoma is rare. We discuss neuroendocrine carcinoma and review the literature.
- The Japanese journal of proctology
The Japanese journal of proctology 60(3), 167-172, 2007-03-01
The Japan Society of Coloproctology