巨大肝を伴った直腸カルチノイドの1例

Carcinoid Tumor of the Rectum with Multiple Liver Metastasis, Report of a Case

要旨　右季肋部の腫瘤に対する初回入院時の腹腔鏡所見では，肝表面の多発性の円型黄白色調の腫瘤が認められ，同生検による病理組織学的所見により肝細胞癌およびその肝内転移と診断された．抗癌剤により腫瘤は縮小した．4回目の入院時では，肝は著しく腫大したが，血液・化学検査には異常所見は認められなかった．下血の精査目的での注腸X線検査で直腸に狭窄がみられた．病理解剖学的には，直腸に3×4cmの結節を認めカルチノイドと診断された．また，肝は腫大し多発性の転移巣を認め，そのほかに前立腺，膀胱，心臓，腎臓，甲状腺にもカルチノイド性組織学的所見が認められた．

　A 57-year-old male patient was admitted to our hospital complaining of the resistance in the right hypochondrium. Laboratory data showed no abnormality. However, ^99mTc-scintigram revealed multiple cold areas in the liver. Biopsy specimen obtained by laparoscopy led to the diagnosis of hepatocellular carcinoma. Chemotherapy was carried out for two years resulting in slight decrease in size.

　During the last hospitalization he developed anal bleeding and constipation. Barium enema showed stenotic change in the rectum. Autopsy revealed a nodular tumor in the rectum, 3×4 cm in size, and metastatic lesions in the liver, lung, thyroid, and kidney. Histological features were all compatible with those of carcinoid tumor.