肛門側ほど癌化傾向を示した同時性多発大腸腫瘍の1例  [in Japanese] A Case of Synchronous Multiple Colorectal Tumors with Anal-Dominant Carcinogenicity  [in Japanese]

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Abstract

症例は68歳の男性で,主訴は貧血と左下腹部痛.既往歴・家族歴に特記すべき所見はなかった.CTと注腸造影検査にて,S状結腸に全周性狭窄を伴う腫瘍を認めた.急性腹症の治療として横行結腸で一時的人工肛門を造設した.下部消化管内視鏡検査では主病巣以外にも全結腸にわたって悪性腫瘍を疑う病変を複数観察した.内視鏡的切除が困難と思われる腫瘍の存在と異時性発癌のリスクを考慮して大腸全摘出術,J型回腸嚢―肛門管吻合術を施行した.摘出標本には脾彎曲部を境に右側結腸で6個の腺腫と1個の腺癌,左側結腸で4個の腺腫と7個の腺癌がみられた.左結腸曲を境に,右側と左側でp53陽性率に有意差を認めた.本症例の発癌過程において,adenoma-carcinoma sequenceの関与に加え,病変部位による腸内環境の違いも影響する可能性が示唆された.

A 68–year–old man admitted for anemia and lower left abdominal pain without hereditary history or familial disease such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC) was found in barium enema and abdominal computed tomography (CT) to have a large circumferential tumor with luminal sigmoid colon stenosis. A temporary stoma was applied at the transverse colon to treat acute abdomen. Several additional lesions suspected of malignancy were too difficult for endoscopic mucosal resection (EMR), necessitating total coloproctectomy and ileal J–pouch anal canal anastomosis to limit high–risk metachronous carcinogenesis. The surgical specimen contained 10 adenomas and eight adenocarcinomas. p53 labeling score differed markedly between the left and right colon. Our case suggests that differing enteral environmental effects associated with tumor location influence the adenoma–carcinoma sequence in neoplastic transformation.

Journal

  • Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 35(4), 621-626, 2010-08-30

    Japanese College of Surgeons

References:  17

Codes

  • NII Article ID (NAID)
    10027657940
  • NII NACSIS-CAT ID (NCID)
    AN00002502
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    03857883
  • Data Source
    CJP  J-STAGE 
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