原発性空腸未分化癌の1例  [in Japanese] A Case of Primary Anaplastic Carcinoma of the Jejunum  [in Japanese]

原発性小腸腫瘍は胃癌や大腸癌に比べ極めて少なく,未分化癌の報告はほとんど認められない.症例は88歳の男性で,発熱,腹部全体の痛みを認めた.血液生化学検査にて炎症所見を認めた.腹部造影CTにて回盲部辺りに小腸壁肥厚を伴う腫瘤性病変を認め,腹水の貯留を認めたがfree airは認めなかった.小腸腫瘍に伴う腹膜炎の診断にて緊急手術となった.開腹すると,濁った腹水を認め,Treitz靭帯から20cmの空腸に腫瘍を認め,Bauhin弁から10cmの回腸に浸潤していた.明らかな穿孔部位は特定できなかった.主病巣と考えられた空腸と一塊となった回腸をそれぞれ切除した.病理組織学的には未分化細胞を認め,免疫染色検査ではCAM5.2,p63陽性で小腸原発未分化癌と診断した.軽快して退院となったが約3か月後,多発性脳転移にて死亡した.原発性小腸未分化癌はまれであり,自験例を含む本邦論文報告14例の検討を行った.

We report a case of undifferentiated cancer of the jejunum. An 88-year-old man with high fever and abdominal pain and found in blood tests to have an inflammation was further found in enhanced abdominal computed tomography (CT) to have a small intestinal tumor with a thickened wall and containing peritoneal fluid. Peritonitis necessitated emergency surgery, showing an intestinal tumor 20cm from the Treitz ligament on the anal side and adhering to the small intestine 10cm from the oral side of the Bauhin valve. Turbid peritoneal fluid was found, but no intestinal perforation. The small intestine was resected extensively. Histologically, the tumor was anaplastic carcinoma. Immunohistochemical examination showed the lesion to be positive for CAM5.2 and p63. The patient recovered enough to be discharged, but he died of multiple brain metastases 3 months postoperatively. Anaplastic carcinoma of the jejunum is rare, with only 14 cases of anaplastic carcinoma of the small intestine reported in the Japanese literature.