転移性卵巣癌と重複癌との鑑別に審査腹腔鏡下手術における腹膜播種病変の生検が有用であった1例

Usefulness of biopsy during laparoscopic surgery in differentiating between metastatic ovarian cancer and double cancer for peritoneal disseminated lesion

◆要旨：患者は52歳，女性．腹部膨満感を主訴に近医を受診し，両側卵巣癌疑いで当院を紹介され受診した．消化管を精査したところ，S状結腸に半周性の2型病変を認め，生検より高分化管状腺癌と診断したが，転移性卵巣癌と重複癌（卵巣癌・S状結腸癌）の鑑別を目的に審査腹腔鏡下手術を施行した．腹膜播種病変の生検結果から病変は卵巣原発腺癌由来であると判断したため，重複癌と最終的に診断した．進行度より予後を決めるのは卵巣癌であると考え，術前化学療法を施行のうえ，外科医師と共同で卵巣癌とS状結腸癌の同時根治手術を施行した．卵巣癌に対する術後補助化学療法としてTC＋Bev療法を6コース終了し，現在はベバシズマブの維持療法を行っている．

　A 52-year-old woman with a chief complaint of abdominal distension was admitted to our hospital with suspected bilateral ovarian cancer. After examining the gastrointestinal tract, a tumor was found in the sigmoid colon, and the patient was diagnosed as having well-differentiated tubular adenocarcinoma by biopsy. Under the circumstances, laparoscopic surgery was performed to identify whether the cancer was metastatic ovarian cancer or double cancer（ovarian cancer and sigmoid colon cancer）. The biopsy of peritoneal disseminated lesion showed that the lesion was derived from the primary adenocarcinoma of the ovary, and the patient was conclusively diagnosed as having double cancer. As the prognosis is judged to be dependent upon ovarian cancer based on the disease progression, neoadjuvant chemotherapy for the ovarian cancer was first performed, followed by simultaneous curative surgery for ovarian cancer and sigmoid colon cancer, performed jointly with surgical doctors. Six courses of postoperative adjuvant chemotherapy for the ovarian cancer were then performed, and bevacizumab maintenance therapy is currently in progress.