原発巣診断に免疫組織学的診断が有用であった小腸腫瘍の1例 A CASE OF SMALL BOWEL CARCINOMA EVENTUALLY DIAGNOSED BY IMMUNOHISTOLOGICAL STUDIES

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症例は52歳,女性.貧血と便秘の精査目的で内科受診.CT検査で骨盤内正中に12×8×13cm大の巨大な腫瘤と空腸近位部に内腔の狭小化を伴う4.5cm大の腫瘤を認め,肝両葉と両肺に多発転移巣を認めた.上下部消化管精査では腫瘍性病変は認めなかった.腫瘍マーカーはCEA 300ng/ml,CA125 10.5U/ml,CA19-9 76,800U/mlであった.術前診断で原発巣が卵巣か小腸か鑑別できなかった.精査中に腹腔内出血をきたしたため緊急手術となり,小腸部分切除,右卵巣腫瘍切除術施行した.免疫組織検査で小腸,卵巣病変ともにCDX2陽性,CK7陰性,CK20陽性であったため小腸原発と診断した.今回われわれは卵巣腫瘍との鑑別診断が非常に困難であり,最終的に免疫組織学的診断が有用であった1例を経験したので,文献的考察を加えて報告する.

A 52-year-old woman was seen at the department of internal medicine in our hospital for close exploration of anemia and constipation. A CT scan showed a 12×8×13 cm huge tumor at the midline of the pelvis and a 4.5 cm-sized tumor with a narrowing lumen at the proximate end of the jejunum, as well as multiple metastases in the both hepatic lobes ad lungs. Upper and lower gastrointestinal examinations revealed no tumor lesions. As for the serum levels of tumor markers, CEA was 300 ng/ml, CA125 was 10.5 U/ml, and CA19-9 was 76,800 U/ml. Preoperative diagnostic procedures could not determine whether the primary lesion was of the ovary or the small intestine. During these examinations, the patient developed intraabdominal bleeding so that emergency operation was performed. Partial excision of the small intestine and removal of the right ovarian tumor were performed. Immunohistological studies resulted in that the both small bowel and ovarian lesions were CDX2 positive, CK7 negative, and CK20 positive. Accordingly the small bowel tumor was diagnosed as the primary lesion. <BR>We herein present this case of small bowel carcinoma which was eventually diagnosed by immunohistological studies after great difficulties in differentiating it from primary ovarian carcinoma, together with bibliographic comments.

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 73(3), 608-612, 2012-03-25

    日本臨床外科学会

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各種コード

  • NII論文ID(NAID)
    10030762318
  • 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  J-STAGE 
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