胃癌治癒切除後の転移性大腸癌の2手術例

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  • TWO OPERATIVE CASES OF METASTATIC COLO-RECTAL CANCER

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Two cases of resectable metastatic colo-rectal cancer are reported. Case 1 was a 75-year-old male, complaining of melena. There was a history of distal gastrectomy performed under a diagnosis of Borrmann type 2 gastric cancer 3 years and 5 months before. Histological findings showed the poorly differentiated adenocarcinoma with signet-ring cell carcinoma. It was absolute curative operation with P0, H0, n1, and pm. This time barium enema radiograph and colonoscopy revealed Borrmann type 3 lesion in the transverse colon and Borrmann type 1 lesion in the descending colon and rectum (Rb). It was difficult to discriminate the lesions from primary multiple colo-rectal cancer preoperatively. Case 2 was a 57-year-old female, complaining of a tumor in the right abdominal region. There was a history of total gastrectomy due to a type 5 gastric cancer 3 years and 9 months before. Histological findings showed poorly differentiated adenocarcinoma with signet-ring cell carcinoma. It was absolute curative operation with P0, H0, n1, and ssγ. This time barium enema radiograph showed the fixed transverse pararell fold and an elevated lesion in the ascending colon. Colonoscopy showed severe stenosis of the lumen with nodular elevations and ulcers. Histological examination of the biopsy specimen demonstrated poorly differentiated adenocarcinoma with signet-ring cell carcinoma in the lamina propria mucosae. It was possible to diagnose case 2 as a metastatic colo-rectal cancer preoperatively. The most probable mode of metastatis to the colon and rectum appeared to be lymphogenic.

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