下行結腸に発生した神経鞘腫の1手術例  [in Japanese] A Surgical Case of Schwannoma of Descending Colon  [in Japanese]

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Abstract

大腸では稀な神経鞘腫の1手術例を経験したので報告する.症例は58歳,女性で,平成6年10月初旬より血便を認あ,当院消化器科を受診した.11月下旬に1日5行以上の下血がみられ,精査のため入院した.注腸造影および大腸内視鏡検査で下行結腸に隆起性病変を認め,下行結腸癌の診断で当科へ転科した.術前の血液生化学検査では軽度の貧血が認められたのみで,腫瘍マーカーは正常範囲にあった.手術所見では,腫瘍は下行結腸に位置し,6×4×2cm大で,表面は壊死物質に覆われていた.また周囲のリンパ節も硬く腫大していた.腫瘍部の術中迅速診断では悪性所見は認あなかったが,肉眼所見で悪性が強く疑われたため,左半結腸切除術を施行した.術後の病理組織学的所見では紡錘形細胞が束状に錯綜しており,免疫染色でS-100蛋白およびVimentin陽性で,下行結腸神経鞘腫と判断された.

A 58-year-old female was admitted to our hospital with melena. Barium enema and colonofiberscopic examinations revealed a protrudent lesion in the descending colon. Biopsy of the lesion showed necrotic tissue and inflammation. The preoperative diagnosis was descending colon cancer, and curative operation, that is, left colectomy with lymph node dissection (D2), was performed because of the malignant appearance. The intraoperative frozen section study showed no malignancy. Histological study showed that the tumor consisted of spindle cells arranged in a bundle pattern. Immunohistochemical studies of the tumor were positive for S-100 protein and vimentin, but negative for smooth muscle actin and desmin. Schwannoma of the intestine is rare, especially in the large intestine. Therefore, a surgical case of schwannoma of the descending colon was reported, and the characteristics of colonic schwannoma, which had been reported in the Japanese literature, were discussed.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 50(2), 125-129, 1997-02-01

    The Japan Society of Coloproctology

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