胃との重複癌を伴った異時性ならびに同時性多発大腸癌の1例

Synchronous and Metachronous Multiple Colorectal Carcinomas with a Synchronous Gastric Carcinoma, Report of a Case

要旨　患者は65歳，男性．癌家族歴はない．18年前に盲腸癌にて右側結腸切除術を受けている．今回，血便と貧血症状が出現し精査を行ったところ，胃1病変ならびに横行結腸1病変，S状結腸1病変，直腸2病変を認めた．胃部分切除術，横行結腸切除術，骨盤内臓器全摘術により治癒切除となった．同時性5多重癌のうち胃も含む3病変について切除標本病理組織検査にてmucinous omponentを認めた．

　We report a case of metachronous and synchronous multiple colorectal adenocarcinomas with a synchronous gastric cancer in a 65-year-old man without a family history of malignancies. He had undergone right hemicolectomy for cecal adenocarcinoma. Eighteen years later, he became anemic and experienced rectal bleeding. An endoscopic finding showed a Ⅱa+Ⅱc lesion in the angle of the stomach. Barium enema examination showed 4 colorectal lesions; a Borrmann I carcinoma in the transverse colon together with an adenomatous lesion, a circumscribed Borrmann Ⅱ lesion in the sigmoid colon invading the urinary bladder, and rectal Borrmann Ⅰ and Ⅱ carcinomas. Partial gastrectomy, partial resection of the transverse colon and total pelvic excenteration were performed with lymph node dissection. The operated specimen showed well-differentiated adenocarcinomas in the four colorectal lesions, two of which contained mucinous component, and a mucinous carcinoma in the gastric lesion.