異時性肝転移を切除しえた盲腸平滑筋肉腫の1例 A Case of Successful Hepatectomy for Heterochronous Hepatic Metastasis of Cecal Leiomyosarcoma

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著者

    • 加藤 浩樹 KATO H.
    • 岐阜県総合医療センター外科 Department of Surgery, Gifu Prefectural General Medical Center
    • 八幡 和憲 YAWATA K.
    • 岐阜県総合医療センター外科 Department of Surgery, Gifu Prefectural General Medical Center
    • 伊藤 元博 ITO M.
    • 岐阜県総合医療センター外科 Department of Surgery, Gifu Prefectural General Medical Center

抄録

症例は59歳男性.上行結腸癌を疑い結腸右半切除術を施行したが,術後の免疫組織学的検索にて盲腸平滑筋肉腫と診断された.14カ月後の腹部US·CT·MRIで肝S5に25×20mmのSOLを指摘され,結腸平滑筋肉腫の異時性肝転移と診断された.局所再発の兆候はなく単発肝転移と診断し肝切除術を施行した.術後病理組織学的に前回の結腸平滑筋肉腫の肝転移と診断された.肝切除術3カ月後の腹部CTで肝S4, S5境界域に23×15mmのSOLが指摘され残肝再発と診断された.再度肝切除術を施行し,免疫組織学的に平滑筋肉腫の肝転移と診断された.再肝切除後12カ月無再発生存中である.消化管平滑筋肉腫は非常にまれな疾患であり,高率に肝転移をおこし今日でも外科的切除しか治療法がない疾患である.消化管平滑筋肉腫の中でも特にまれな盲腸平滑筋肉腫に発症した異時性肝転移に対し,2度の切除を行った症例を経験したので報告する.<br>

A 59-year-old man underwent right hemicolectomy under the diagnosis of ascending colon cancer. Postoperative immunohistochemical examination led to a diagnosis of leiomyosarcoma of the colon. Approximately 14 months later, abdominal US, CT, and MRI revealed a 25×20-mm SOL in liver S5, which was diagnosed as a heterochronous hepatic metastasis from leiomyosarcoma. Since there were no signs of local recurrence, simple hepatic metastasis was diagnosed, and hepatectomy was performed. After surgery, the resected tumor was histopathologically diagnosed as hepatic metastasis of the previous colon leiomyosarcoma. Three months after hepatectomy, abdominal CT showed a 23×15-mm SOL in the S4-S5 border, which was diagnosed as residual liver recurrence. Re-hepatectomy was performed, and the resected tumor was immunohistochemically diagnosed as hepatic metastasis of leiomyosarcoma. The patient has been free of recurrence for 12 months after re-hepatectomy. Leiomyosarcoma of the gastrointestinal tract is a very rare disease, frequently metastasizes to the liver, and can only be treated by surgical resection. We report a case of successful hepatectomy for two heterochronous hepatic metastases of cecal leiomyosarcoma, a very rare digestive leiomyosarcoma.<br>

収録刊行物

  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(3), 141-146, 2008-03-01 

    The Japan Society of Coloproctology

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