短期間のうちに急速に進行した上行結腸内分泌細胞癌の1例

Rapidly Progressed Endocrine Cell Carcinoma in the Ascending Colon, Report of a Case

要旨　患者は59歳，女性．自覚症状はなく，便潜血反応陽性を主訴に近医を受診し，カルチノイド腫瘍の疑いで紹介となった．上行結腸に約4cm大で2型の病変を認めた．前医で行われた2か月前の内視鏡検査では，表面にびらんを伴う隆起性病変であり，短期間のうちに著明な形態変化を認めた．生検では，核異型が高度で一部にロゼット様構造を認めたため，内分泌細胞癌が示唆された．組織学的には内分泌細胞癌，se，n3，P0，H0，Stage IIIb，ly2，v2，壁内転移陽性，根治度Aであったが，術後4か月で癌死した．本症は極めて予後不良かつまれな疾患であるが，自験例はその自然史を解明する上で貴重な症例と考えられた．

　The patient was a 59-year-old female without subjective symptoms who visited a local physician with the chief complaint of fecal occult blood. She was referred to our hospital with a diagnosis of carcinoid tumor. A type-2 lesion approximately 4 cm in size was observed in the ascending colon. Endoscopy conducted 2 months earlier by her previous physician showed that the lesion was a protruded lesion with erosive surface, which demonstrated marked morphological changes over a short period. Endocrine cell carcinoma was suspected from the biopsy, based on severe dyskaryosis and rosette-like structure in some areas and an operation was performed. While histologically, the tumor was an endocrine cell carcinoma classified as “se, n3, P0, H0, Stage IIIb, ly2, v2” with positive intramural metastasis whose radical cure rating was “A”, the patient died of multiple liver metastasis 4 months following the surgery. The case was considered to be a valuable case which might be helpful in determining the natural history of this rare disease that has an extremely poor prognosis.

　1) Department of Surgery, Kumamoto Red Cross Hospital, Kumamoto, Japan