盲腸癌に併存した肝reactive lymphoid hyperplasiaの1例  [in Japanese] Reactive Lymphoid Hyperplasia of the Liver Mimicking Liver Metastasis in a Patient with Cecal Cancer  [in Japanese]

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Abstract

症例は57歳の女性.右下腹部腫瘤の精査で盲腸癌と診断された.術前の腹部超音波検査で肝S2に径10mmの境界明瞭で内部不均一な低エコー腫瘤を認めた.CT検査では淡い低吸収域として認め,造影効果は認めなかった.MRI検査ではT1強調で低信号,T2強調で軽度高信号を示し,superparamagnetic iron oxide(SPIO)造影後T2強調で明瞭な高信号として描出され,拡散強調画像で拡散の低下を認めた.盲腸癌・転移性肝癌と診断し,回盲部切除術と肝部分切除術を施行した.病理組織学的所見で肝reactive lymphoid hyperplasiaと診断された.術後8年再発なく経過している.肝reactive lymphoid hyperplasiaは良性疾患とされているが,術前検査で悪性腫瘍との鑑別が困難であり,外科的切除が行われることが多い.診断,治療の現状と問題点を考察した.

A 57-year-old woman was referred to Jichi Medical University Hospital for evaluation of an abdominal mass. Cecal cancer was diagnosed on colonoscopy. Abdominal ultrasonography detected a 10-mm mass in segment 2 of the liver. Computed tomography demonstrated a lesion without contrast enhancement. Magnetic resonance imaging showed a mass with low signal intensity on T1-weighted imaging, high intensity on T2-weighted imaging and high intensity on diffusion-weighted imaging. No uptake of superparamagnetic iron oxide was seen. Advanced cecal cancer with isolated liver metastasis was diagnosed, and ileocecal resection with partial liver resection was performed. The postoperative course was uneventful. On pathological examination, the liver lesion was identified as reactive lymphoid hyperplasia. The cecal cancer was pSI, ly0, v2, pN0, fStage II. She remains alive without recurrence as of 8 years after treatment. Reactive lymphoid hyperplasia is a benign disease, but is difficult to diagnose preoperatively, especially in patients with synchronous malignancy. We review current opinions and problems for this rare disease.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 76(10), 2493-2498, 2015

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130005149532
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    030765935
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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