大腸sm癌で内視鏡的切除後に骨盤内再発を呈した1例

Rectal Submucosal Carcinoma Recurred in the Pelvis Eight Years after Polypectomy, Report of a Case

要旨　患者は38歳，男性．直腸Rbに8mm大の広基性ポリープを指摘され，内視鏡下にポリペクトミー施行，残存ポリープに再度内視鏡下にポリペクトミー施行した．高分化腺癌で，断端陽性であったため，経仙骨的に直腸を部分切除した．手術標本には，腫瘍の残存が認められなかった．手術後8年目に，CT上骨盤内に8cm大の局所再発と発見された．第2回目ポリペクトミー標本を見直したところ，粘膜下層のリンパ濾胞内に癌細胞が認められた．動注化学療法・放射線治療が行われ，腫瘍は5cm大にまで縮小し，再発の発見後3年以上生存している．大腸sm癌の治療方針の決定においては，病理医と外科医の緊密な関係が重要である．

　A 38-year-old man received polypectomy for a broad based polyp, 8 mm in size, in the lower rectum by colonoscopy. A second-time polypectomy was performed for residual polyp. The histological examination revealed adenocarcinoma with positive cut margin. Local excision was performed, but no cancer was detected in the surgical specimen. Eight years after the operation, a recurrent lesion, 8 cm in size, was detected in the pelvis. Re-examination of the second-time polypectomy specimen revealed carcinoma cells in a lymph follicle in the submucosal layer. Chemotherapy and irradiation have reduced the recurrent lesion from 8 cm to 5 cm, and the patient has survived more than three years after the discovery of the local recurrence. It is suggested that close communication between pathologists and surgeons should be employed in the making decision whether colorectal submucosal carcinoma has been cured or not.