上行結腸癌に対する腹腔鏡補助下手術後に発症した腹腔内デスモイド腫瘍の1切除例  [in Japanese] A Case of Resectable Intra-abdominal Desmoid Tumor after Resection of Ascending Colon Cancer  [in Japanese]

Search this Article

Author(s)

Abstract

腹腔内癌術後の腹腔内デスモイド腫瘍の診断は,癌再発との鑑別が困難である.症例は70歳の男性で,上行結腸癌(SE,N0,H0,M0,P0:Stage II)に対して腹腔鏡補助下結腸右半切除術を施行した.術後1年6か月目の画像検査で十二指腸腹側に径3cmの腫瘤を認め,CT,MRIではリンパ節再発を疑う所見であったが,positron emission tomography(以下,PET)-CTではSUVの最大値は早期相1.95から後期相2.05と軽度上昇にとどまり,癌再発は否定的であった.手術は十二指腸壁と上腸間膜静脈壁の一部を合併切除する腫瘍摘出術を行った.病理組織学的検査では結腸腸間膜原発デスモイド腫瘍と診断され,PET-CTでの術前診断が癌再発との鑑別に有用であると判断された.家族性大腸腺腫症を伴わない腹腔内手術後の腹腔内デスモイド腫瘍発生はこれまで20例が報告されているが,本症例のごとく腹腔鏡手術後発生の報告はない.

Intraabdominal desmoid tumor and cancer recurrence may be difficult to differentiate following intraabdominal cancer surgery. A 70-year-old man being followed up after laparoscopic-assisted ascending colon cancer surgery was indicated in computed tomography (CT) and magnetic resonance imaging (MRI) findings to have recurrent cancer suggested by a tumor in the ventral duodenum adjacent to the previous surgical scar and vascular clip. Positron emission tomography as (PET) CT, however, did not indicate cancer recurrence. Surgery for resecting the tumor together with part of the duodenal and superior mesenteric vein wall 1.5 years after the previous operation showed an isolated 4×4×4cm hard elastic tumor with a smooth surface and a solid whitish cut surface. Histopathological findings indicated an intraabdominal desmoid tumor originating in the jejunal mesenterium and invading the superior mesenteric vein wall and muscular layer of the duodenum. No signs of recurrence were seen in followup 6 months after surgery. Although, 20 cases of intraabdominal desmoid tumor without familial adenomatous polyposis after intraabdominal surgery have been reported in the Japanese literature, our case would be the first of intraabdominal desmoid tumor without familial adenomatous polyposis after laparoscopic surgery. PET-CT thus proved very useful in differentiating between intraabdominal desmoid tumor and cancer recurrence after intraabdominal cancer surgery.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 43(1), 95-100, 2010-01-01

    The Japanese Society of Gastroenterological Surgery

References:  34

Cited by:  4

Codes

  • NII Article ID (NAID)
    110007503961
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJP  CJPref  NII-ELS 
Page Top