多発性肝・骨転移を来した大腸sm癌の1例

Early Colonic Cancer Associated with Liver and Bone Metastasis, Report of a Case

要旨　患者は61歳，男性．便潜血反応陽性のため施行した注腸X線検査で盲腸に隆起性病変が指摘され当科に紹介された．内視鏡所見はIIa+IIc型のsm癌(生検では低分化型腺癌)であり外科的切除の適応と判断した．開腹所見はP₀，H₀，N₀，S₀(stageI)であったが，組織型を考慮し回盲部切除術(D₃郭清)を施行した．病理組織所見は，poorly differentiated adenocarclnoma，1.8×1.7cm，sm₃，INFβ，1y₀，v₃，n₀(0/11)であった．術後7か月に多発性肝転移が発見されたため再入院となり，肝動注療法(5-FU，Cysplatin)を開始した．術後9か月には多発性骨転移(椎骨，肋骨)が確認され，放射線療法，全身化学療法を行ったが，原発巣手術から1年1か月で死亡した．解剖所見では肺転移，リンパ節転移は認められなかった．

　A polypoid lesion 1.5cm in diameter was detected by barium enema in the cecum of an asymptomatic 61year-old man, following a positive fecal occult blood test. Colonoscopy revealed a IIa+IIc type lesion, suggestive of invasive carcinoma. Ileocecal resection with D₃ lymph node dissection was performed. The histology of the lesion was poorly differentiated adenocarcinoma invading the submucosa. Venous invasion was positive but lymphatic invasion was negative. Resected lymph nodes were all free of metastasis. Multiple liver tumors were detected seven months after the operation and injection of 5-FU and Cysplatin was started through the hepatic artery catherter. Multiple bone metastases were found nine months after the operation. Systemic chemotherapy and irradiation were perfomed but the patient died of tumor dissemination one and one month year after the ileocecal resection. A small carcification in the left lung, multiple metastases in both lobes of the liver, and all vertebras and in ribs were found at autopsy. Lymph node metastases and pulmonary metastases were not found.