虫垂切除断端に発生した虫垂粘液囊胞腺腫に対する腹腔鏡補助下回盲部切除術の1例

Laparoscopic-assisted ileocecal resection for mucinous cystadenoma of appendiceal remnant after appendectomy : a case report

◆要旨：患者は59歳，男性．下部消化管内視鏡検査で盲腸底部に粘膜下腫瘍を認めた．27歳時に急性虫垂炎に対する虫垂切除術の既往があった．超音波内視鏡検査や腹部造影CTで直径30mmの囊胞性病変の形態を呈し，リンパ節腫大も認めた．腫瘍マーカーはCEAが軽度上昇していた．以上より，虫垂切除断端に生じた虫垂粘液囊腫と診断し，腹腔鏡補助下回盲部切除術を施行した．悪性の可能性も否定できないため，D3郭清を施行した．病理組織学的検査では，虫垂入口部付近の遺残虫垂粘膜から発生した虫垂粘液囊胞腺腫の診断であり，悪性所見は認めなかった．虫垂切除断端に虫垂粘液囊胞腺腫が発生した報告はきわめて稀であるため，若干の文献的考察を加え報告する．

A 59-year-old man was admitted to our hospital due to submucosal tumor in the terminal cecum on colonoscopy. There was a previous history of appendectomy for acute appendicitis at the age of 27. Ultrasonography and abdominal enhanced computed tomography scan showed a cystic lesion, 30 mm in diameter, and an enlarged lymph node. The serum CEA level was high. Because the possibility of malignancy could not be excluded, laparoscopic-assisted ileocecal resection with D3 lymph node dissection was performed. Postoperative histopathological examination showed that the resected lesion was a mucinous cystadenoma of the appendix without any malignant change, originating from a remnant of the appendix mucosa after appendectomy. Mucinous cystadenoma of appendiceal remnant after appendectomy is particularly rare. We describe this case with a review of the literature.