CEA産生空腸癌の1例

Tissue CEA Content and CEA Specific Staining in a Case of CEA-producing Jejunal Cancer

　小腸は全消化管長の75％，全消化管粘膜総面積の85％を占めているが，癌の発生頻度は極めて低く，全消化管の約1％¹⁾と言われ，本院での総消化管癌手術症例における小腸癌の頻度は，0.12％であった．最近，腹部不快感を主訴として来院し，血清CEA高値を呈した空腸癌を切除し，組織内CEAの酵素抗体法による特異染色と，CEAの定量を行い，CEA産生空腸癌と考えられる所見を得たので報告する．

　A 51-year-old woman with abdominal discomfort and intermittent vomiting was referred to our hospital. Investigation showed high serum CEA level (37ng/ml) and severe hypochromic anemia. A narrowed lesion located in the jejunum, 20 cm distal to Treitz's ligament, was noted by barium meal examination and superior mesenteric arteriography demonstrated a tumor staining consistent with this lesion.

　Under diagnosis of jejunal cancer, laparotomy was performed. Localized narrowed lesion existed in the jejunum with several metastatically enlarged nodes. In Douglas' pouch, a disseminated metastatic lesion was found.

　Histological study of resected specimen revealed moderately differentiated adenocarcinoma with serosal infiltration.

　Postoperatively serum CEA level decreased to 23 ng/ml, but elevated again when lung and liver metastases were found.

　The patient died of multiple tumor relaps one year after the operation. Tissue CEA content of resected specimen was measured and CEA staining using immuno-peroxidase method was performed. Tissue CEA content of the lesion where CEA was stained positively was 27,000 ng/wet g, which was 30 times higher than that of the adjacent normal jejunum.

　Thus this tumor was diagnosed as a CEA-producing cancer in the jejunum.