腸重積を契機に発見された上行結腸髄様癌の1例  [in Japanese] A Case of Medullary Carcinoma of the Ascending Colon with Intussusception  [in Japanese]

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Author(s)

    • 矢後 彰一 YAGO Akikazu
    • 横浜市立大学医学部消化器・腫瘍外科学 Department of Gastroenterological Surgery, Yokohama City University
    • 石部 敦士 ISHIBE Atsushi
    • 横浜市立大学医学部消化器・腫瘍外科学 Department of Gastroenterological Surgery, Yokohama City University
    • 遠藤 格 ENDO Itaru
    • 横浜市立大学医学部消化器・腫瘍外科学 Department of Gastroenterological Surgery, Yokohama City University

Abstract

症例は63歳,男性.腹部超音波検査で偶発的に腹腔内腫瘤を指摘され,CTで上行結腸肝弯曲部において重積所見を認め,大腸内視鏡検査で腸重積と診断された.腸重積による臨床症状を認めなかったことから待機的手術の方針となり,腹腔鏡下結腸右半切除術を施行された.病理組織像では地図状の胞巣を形成し,高度のリンパ球浸潤を伴う増殖を認め,髄様癌と診断された.術後は合併症なく経過し,術後8日目に退院となった.<BR>大腸髄様癌は取扱い規約第8版に初めて記載された比較的新しい概念の組織型である.大腸髄様癌は特徴的な組織像を伴い,右側結腸に好発,比較的予後良好である.膨張性に増殖するため腫瘍径は比較的大きく,発見時には既に漿膜面に浸潤していることが多い.今回,腸重積症を契機に発見された上行結腸髄様癌の1例を経験したため,結腸腸重積の臨床的特徴も踏まえ,若干の文献的考察を加えて報告する.

A 63-year-old man was incidentally found on abdominal ultrasonography to have an intra-abdominal tumor. Computed tomography (CT) showed a tumor in the ascending colon at the hepatic flexure, which was diagnosed as intussusception by colonoscopy. Since he had no symptoms, elective surgery was planned, and laparoscopic right hemi-colectomy was performed. On histopathological examination, a map-like alveolar lesion and proliferation with marked lymphocyte infiltration was observed, and medullary carcinoma of the colon was diagnosed. The patient's postoperative course was good without any complications, and he was discharged on the 8th postoperative day.<BR>Medullary carcinoma of the colon is a relatively new concept described for the first time in the 8th Japanese Classification of Colon Cancer. It is most commonly found in the right-sided colon and has a relatively good prognosis. The tumor diameter is relatively large, and it has often already infiltrated into the subserosal layer at the time of diagnosis. A case of medullary carcinoma of the ascending colon with intussusception is presented along with relevant literature based on the clinical features of colonic intussusception.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(9), 1885-1889, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007629037
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029293005
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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