G-CSF産生直腸未分化癌の1例 A CASE OF GRANULOCYTE-COLONY STIMULATING FACTOR (G-CSF)-PRODUCING UNDIFFERENTIATED CARCINOMA ARISING IN THE RECTUM

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本論文では原発巣切除術後に急速な再発転移をきたして死亡したG-CSF産生直腸未分化癌の1例について報告する.症例は63歳,男性.直腸に1型腫瘤があり,生検では未分化癌が示唆されたが,遠隔転移はなく(Stage IIIb),腹会陰式直腸切断術を実施した.しかし術後早期に骨盤腔内再発や,多発肝・肺転移,発熱と高G-CSF血症を伴う白血球増多が出現,急激に全身状態が悪化して術後第26病日に死亡した.切除標本の組織所見は未分化癌で,免疫染色ではp53とKi-67が強陽性だが,特定の由来臓器を示す所見はなかった.また,G-CSF陽性でありG-CSF産生腫瘍であることが示された.本邦における直腸原発G-CSF産生未分化癌の報告はなく,腫瘍によるG-CSF産生の臨床的意義についても未解決であり,今後の症例の蓄積と検討が待たれるところである.

This paper deals with a case of granulocyte-colony stimulating facor (G-CSF)-producing undifferentiated carcinoma of the rectum in which the disease rapidly progressed to its termination after resection of the primary lesion. A 63-year-old man was admitted to our hospital for thorough examination of a large tumor of the rectum, for which undifferentiated carcinoma was suggested. Because of bleeding from the tumor and no evident metastasizing lesions demonstrated by PET-CT, we performed abdominoperineal rectum resection. However, it became apparent by the 11<SUP>th</SUP> postoperative day that the disease had relapsed in the pelvic cavity with multiple metastasizing lesions in the liver and lungs. Also noted were a high-grade fever with marked leukocytosis (>110000/μl) and an elevated serum G-CSF level (115pg/ml) during this period. Afterwards, the patient's condition rapidly deteriorated and he died 26 days after the surgery. Microscopic examination including immunohistochemical staining gave a diagnosis of undifferentiated carcinoma. Furthermore, tumor cells positively stained for anti-G-CSF antibody.<BR>Reports of undifferentiated carcinoma arising in the large bowel are extremely rare and, to the best of our knowledge, no G-CSF-producing undifferentiated carcinoma of the rectum has not been documented to date. Thus, the significance of G-CSF in the clinical course and therapeutic strategies for such patients remain unresolved. Nevertheless, a review of the literature suggests that early detection followed by complete resection of such tumors would be the best possible therapeutic modality at this point.

収録刊行物

  • 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 69(7), 1737-1741, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944839
  • 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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