内視鏡的切除後に遠隔転移再発を来した上行結腸T1癌の1例

Distant Metastatic Recurrence after Endoscopic Resection T1 Carcinoma of the Ascending Colon, Report of a Case

要旨●患者は70歳代，女性．便潜血陽性に対する精査目的の大腸内視鏡検査で上行結腸に35mm大の0-Is型病変を認め，精査加療目的に当センターへ紹介され受診となった．術前CTではリンパ節転移，遠隔転移は認めなかった．当センターでの大腸内視鏡検査では，粘膜内癌と診断し，内視鏡的粘膜下層剝離術を施行した．最終病理診断は，carcinoma（tub1>tub2）in adenoma，pT1a（440μm），Ly0，V0，BD1であり，追加腸切除を施行せず，経過観察の方針とした．しかしながら，内視鏡治療後19か月で施行した腹部超音波検査で肝転移再発を認め，化学療法を施行したが，治療後45か月で永眠された．大腸T1癌の遠隔転移再発はまれとされ，腸管切除を行ったとしても再発する可能性があり，T1癌治療後にはより慎重な対応が求められる．

　We report the case of a woman in her 70s, in whom after colonoscopy for positive fecal occult blood a 35-mm large 0-Is lesion was found. No lymph node metastasis or distant metastasis was found in preoperative imaging. Based on the endoscopic findings at our center, the patient was diagnosed with intramucosal carcinoma ; thus, endoscopic submucosal dissection was performed. The pathological diagnosis was carcinoma（tub1>tub2）in adenoma, pT1a（440μm）, ly0, v0, and BD1, and we decided to observe the patient without additional bowel resection. After 19 months of endoscopic treatment, abdominal ultrasonography revealed recurrence of liver metastasis, and thus, chemotherapy was administered ; however, the patient died 45 months after treatment. Although distant metastatic recurrence of T1 colorectal cancer is rare, it can occur after bowel resection and requires more care in post-treatment.