腹腔鏡下手術で切除したS状結腸原発の髄外性形質細胞腫の1例

Primary isolated extramedullary plasmacytoma of the sigmoid colon radically resected by laparoscopic surgery : a case report

◆要旨：患者は61歳，男性で，便秘のため近医で下部消化管内視鏡検査を施行され，生検で形質細胞腫と診断され当院を受診した．精査の結果，S状結腸原発の孤立性髄外性形質細胞腫と診断し，腹腔鏡補助下S状結腸切除術＋リンパ節郭清術を施行した．病理組織所見では，粘膜固有層から粘膜下層にかけて形質細胞の増殖を認めた．リンパ節転移は認めず，治癒切除と診断した．術後4年経過し，無再発生存中である．大腸原発の孤立性髄外性形質細胞腫は，治癒切除が可能であれば手術が基本であるが，そのアプローチ方法において腹腔鏡下手術は治療法として妥当であると思われた．

　A 61-year-old male patient who presented with diarrhea had undergone a total colonoscopy, was diagnosed as having plasmacytoma by biopsy, and then he visited our hospital. He was diagnosed as having primary isolated extramedullary plasmacytoma originating in the sigmoid colon, and was subsequently subjected to a laparoscopy-assisted sigmoidectomy with lymph nodes dissection. Histopathological findings demonstrated the proliferation of plasma cells from the lamina propia mucosae to the submucosal layer. Lymph node metastasis was not found, and thus, the patient was considered as a “curative resection” case. He has survived event-free for 4 years after the surgery so far.

　Surgery is the principal method for the treatment of solitary EMP originating in the large intestine, and we show here that laparoscopic surgery is an effective therapeutic option, thus, it may be adopted as a standard procedure for treatment of EMP.