虫垂炎症状を繰り返した虫垂goblet cell carcinoidの1例

A case of goblet cell carcinoid of appendix with repeated appendicitis

◆要旨：虫垂goblet cell carcinoidの1例を経験した．患者は66歳，女性．右下腹部痛を主訴に受診した．急性虫垂炎と診断され，抗菌薬による保存的治療を行い軽快した．待機的虫垂切除を勧めたが経過観察を希望した．その後症状を繰り返し最終的に膿瘍形成を伴う虫垂炎を発症したため腹腔鏡下虫垂切除術を施行した．病理組織学的検査にて虫垂goblet cell carcinoid（深達度T4a）と診断され，腹腔鏡下回盲部切除術D3リンパ節郭清を施行した．切除標本では盲腸の粘膜下から固有筋層内に4mm程の範囲に異型細胞が残存していた．脈管侵襲，リンパ節転移は認めなかった．術後補助化学療法を施行し，現在再発所見はない．虫垂炎を繰り返す症例は稀な虫垂原発腫瘍の合併を念頭に，積極的に虫垂切除を勧めるべきと考えられる．

We report a case of goblet cell carcinoid of the appendix presented with repeated appendicitis. A 66-year-old woman was admitted to our hospital with right lower abdominal pain. The patient was diagnosed as having acute appendicitis, and underwent non-operative management with antibiotics because of mild symptom. Although we recommended interval appendectomy, the patient preferred non-operative management. Appnedicitis repeatedly occurred. Eventually, laparoscopic appendectomy was performed because of developing abscess. The histological diagnosis was goblet cell carcinoid of the appendix. Owing to serosal invasion, laparoscopic ileocecal resection with D3 dissection was added. Residual lesion was identified in the cecum of resected specimen. There has been no sign of recurrence after adjuvant chemotherapy. Appendectomy is highly recommended for patients having repeated appendicitis because of the possibility of associated appendiceal tumor.