血清CEA高値を契機に発見された虫垂粘液嚢胞腺腫の2例 Two Cases of Mucinous Cystadenoma of the Appendix Incidentally Found in Patients with Elevated Serum CEA Level
症例1は85歳, 女性。近医にてCEA9.2ng/mlと高値を指摘され当科紹介となった。CT検査, 超音波検査で虫垂部に嚢胞状腫瘤を認めた。注腸造影検査では盲腸下端に半球状の表面平滑な隆起性病変を認め, 虫垂は造影されなかった。虫垂粘液嚢腫の診断で盲腸部分切除術を施行し, 術後CEAは4.7ng/mlと正常化した。 症例2は74歳, 女性。高血圧, 高脂血症で当科通院中にCEA12.3ng/mlと高値を示し, CT検査, 超音波検査で虫垂部に嚢胞状腫瘤を認めた。注腸造影検査では盲腸に粘膜下腫瘍様隆起を認め, 虫垂は造影されなかった。虫垂粘液嚢腫の診断で盲腸部分切除術を施行し, 術後CEAは1.5ng/mlと正常化した。 いずれも病理検査で虫垂粘液嚢胞腺腫と診断され, 免疫染色ではCEA陽性であった。
Case I was a 85-year-old woman. She was referred to us as her serum CEA level was found as high as 9.2ng/ml at a clinic in her neighborhood. CT and ultrasound scans revealed a cystic tumor in the appendix area. A barium enema examination showed a tubercular lesion in the subcecal area. The surface of the lesion was flat and smooth. The vermiform appendix was not scanned with the contrast medium. She was diagnosed with mucinous cystadenoma of the appendix. Partial cecotomy was performed. The postoperative serum CEA fell to a normal level of 4.7ng/ml. Case II was also a woman . The 74- year-old inpatient was being treated for high blood pressure and hyperlipemia when her serum CEA level was found elevated to 12.3ng/ml. CT and ultrasonograph examinations revealed a cystic tumor in the appendix area. A barium enema examination showed a mucocele-like tubercle in the appendix. The patient was diagnosed with mucinous cystadenoma of the appendix and partial cecotomy was performed. The CEA level was normalized postoperatively with 1.5ng/ml. The pathologic tests confirmed either of these two cases was mucinous cystadenoma of the appendix. Immunohistochemical staining showed a CEA positive.
日本農村医学会雑誌 63(1), 49-56, 2014