肝転移再発を来した大腸sm癌の1例

Submucosal Invasive Cancer of the Sigmoid Colon, Recurring as Liver Metastasis One Year and Five Months Postoperatively, Report of a Case

要旨　患者は47歳，男性．下血のため近医を受診し，注腸X線検査でポリープを指摘された．当院を紹介され，大腸内視鏡検査でS状結腸に大きさ約1.2cmの亜有茎性のポリープを認め，ポリペクトミーを行った．病理検査の結果，組織型は高～中分化腺癌，深達度sm₂，脈管侵襲陽性，断端は癌陰性であった．約8か月後に1群のリンパ節郭清を伴うS状結腸部分切除術を施行．開腹所見はH₀，P₀，S₀，n₀で，切除標本に癌の遺残は認めなかった．術後約1年5か月後に肝転移再発を来したが，局所再発，リンパ節転移は共に認めなかった．CEA(Z-gel法)は，腸切除前の1.7ng/mlに比較して，肝転移発見時は820ng/mlと著明に上昇していた．術後約2年4か月後に死亡した．

　The patient was a 47-year-old man, who visited his neighborhood doctor complaining of melena. A colon polyp was detected by barium enema study. He was referred to ourhospital for endoscopic polypectomy. Colonoscopic examination revealed a semi-pedunculated polyp in the sigmoid colon, ca. 1.2 cm in size. A polypectomized specimen showed well to moderately differentiated adenocarcinoma, of depth sm₂, with infiltration of the vessels, but its stump was cancernegative. About eight months after this operation, partial sigmoidectomy with R₁lymphatic dissection was performed. The laparotomy finding was H₀, P₀, S₀, n₀. Surgical specimen showed no residual cancer. Multiple liver metastases were detected about one year and five months postoperatively, but neither regional recurrence nor lymph nodal metastasis was noted. CEA (Z-gel method) increased remarkably from 1.7ng/ml (w.n.l.) at surgical resection to 820ng/ml at the time of the detection of liver metastasls. The patient died about two years and four months postoperatively.