内容紹介
Two Cases of Colon Metastasis of Gastric Cancer by Different Metastasis Pathway
Summary
We treated 2 cases of colon metastasis of gastric cancer considered to be caused by different pathway. Case 1 was a 55-year-old male with gastric cancer associated with metastases for lymph node, gallbladder, and liver. Curative surgical treatment of distal gastrectomy, partial hepatectomy, cholecystectomy and lymph node dissection was performed. The final finding was, L, Less, Type 3, pT4b(GB), tub2, pN3a(10/20), sP0, CY0, pH1, pM1, Stage Ⅳ, R0. Ten months after, ileocecal resection was performed, as a tumor was detected in the cecum. It was a submucosal tumor of well to moderately differentiated adenocarcinoma, and diagnosed as a metastasis of gastric cancer. Case 2 was a 59-year-old male who received total gastrectomy. The final finding was UE, Less, Type 4, tub2-por2, pT4a, pN2(5/19), cM0, sP0, CY0, Stage ⅢB, R1. One year and 10 months later, unevenness and redness in the mucosal membrane of the transverse colon occurred. Signet-ring cells were observed by the endoscopic biopsy, and colon metastasis of stomach cancer was diagnosed. Consequently, transverse colectomy was performed. Diffused invasion of cancer cells was observed in all layers of the wall, which was considered as metastasis via gastrocolic ligament. Although colon metastasis of stomach cancer is rare, its pathway varies, such as infiltration, direct invasion, hematogenous, and lymphogenous. Form of lesion also varies. For diagnosis of colon lesion occurring during follow-up after gastric cancer, these points should be noted.
要旨
異なる経路によると考えられる胃癌結腸転移の2切除例を経験したので報告する。症例1は55歳,男性。肝と胆嚢壁内に転移を伴う幽門部胃癌に対し,幽門側胃切除,肝部分切除,胆摘,Roux-en-Y(R-Y)再建を施行した。L,Less,Type 3,pT4b(GB),tub2,pN3a(10/20),sP0,CY0,pH1,pM1,Stage Ⅳ,R0。経過観察中,盲腸に腫瘤を生じ,10か月目で回盲部切除を施行した。病変は直径25 mmの粘膜下腫瘍で組織学的に中～低分化型の腺癌であり,胃癌の血行性結腸転移と診断した。症例2は59歳,男性。体上部胃癌にて胃全摘術,R-Y再建を施行した。UE,Less,Type 4,tub2～por2,pT4a,pN2(5/19),cM0,sP0,CY0,Stage ⅢB,R1。1年10か月後,横行結腸に粘膜の不整と発赤,壁の肥厚像を認め,生検では印環細胞が得られ,胃癌の結腸転移と診断し横行結腸切除術を施行した。腸管壁全層にびまん性の癌細胞浸潤を認め,胃結腸間膜を介した浸潤による転移が考えられた。胃癌結腸転移はまれであるが,その経路は播種,直接浸潤,血行性,リンパ行性など多様であり,病変の形態も変化に富む。胃癌術後に生じた結腸病変の診断については,これらを念頭に置くべきであると思われた。
目次
Summary
We treated 2 cases of colon metastasis of gastric cancer considered to be caused by different pathway. Case 1 was a 55-year-old male with gastric cancer associated with metastases for lymph node, gallbladder, and liver. Curative surgical treatment of distal gastrectomy, partial hepatectomy, cholecystectomy and lymph node dissection was performed. The final finding was, L, Less, Type 3, pT4b(GB), tub2, pN3a(10/20), sP0, CY0, pH1, pM1, Stage Ⅳ, R0. Ten months after, ileocecal resection was performed, as a tumor was detected in the cecum. It was a submucosal tumor of well to moderately differentiated adenocarcinoma, and diagnosed as a metastasis of gastric cancer. Case 2 was a 59-year-old male who received total gastrectomy. The final finding was UE, Less, Type 4, tub2-por2, pT4a, pN2(5/19), cM0, sP0, CY0, Stage ⅢB, R1. One year and 10 months later, unevenness and redness in the mucosal membrane of the transverse colon occurred. Signet-ring cells were observed by the endoscopic biopsy, and colon metastasis of stomach cancer was diagnosed. Consequently, transverse colectomy was performed. Diffused invasion of cancer cells was observed in all layers of the wall, which was considered as metastasis via gastrocolic ligament. Although colon metastasis of stomach cancer is rare, its pathway varies, such as infiltration, direct invasion, hematogenous, and lymphogenous. Form of lesion also varies. For diagnosis of colon lesion occurring during follow-up after gastric cancer, these points should be noted.
要旨
異なる経路によると考えられる胃癌結腸転移の2切除例を経験したので報告する。症例1は55歳,男性。肝と胆嚢壁内に転移を伴う幽門部胃癌に対し,幽門側胃切除,肝部分切除,胆摘,Roux-en-Y(R-Y)再建を施行した。L,Less,Type 3,pT4b(GB),tub2,pN3a(10/20),sP0,CY0,pH1,pM1,Stage Ⅳ,R0。経過観察中,盲腸に腫瘤を生じ,10か月目で回盲部切除を施行した。病変は直径25 mmの粘膜下腫瘍で組織学的に中～低分化型の腺癌であり,胃癌の血行性結腸転移と診断した。症例2は59歳,男性。体上部胃癌にて胃全摘術,R-Y再建を施行した。UE,Less,Type 4,tub2～por2,pT4a,pN2(5/19),cM0,sP0,CY0,Stage ⅢB,R1。1年10か月後,横行結腸に粘膜の不整と発赤,壁の肥厚像を認め,生検では印環細胞が得られ,胃癌の結腸転移と診断し横行結腸切除術を施行した。腸管壁全層にびまん性の癌細胞浸潤を認め,胃結腸間膜を介した浸潤による転移が考えられた。胃癌結腸転移はまれであるが,その経路は播種,直接浸潤,血行性,リンパ行性など多様であり,病変の形態も変化に富む。胃癌術後に生じた結腸病変の診断については,これらを念頭に置くべきであると思われた。