内容紹介
A Case of Metastatic Carcinoma of Anal Fistula
Summary
A 58-year-old man underwent rectal resection(D2 dissection)for rectal cancer and liver/lung metastases in August 2009. Histopathological findings were Ra, type 2, 70×80 mm, tub1>tub2, int, pSI(peritoneum), INF b, ly1, v1, pN1(2/13), pPM0, pDM0, M1a(H1, PUL1), fStageⅣ. The lung metastasis had disappeared on chest CT after postoperative chemotherapy and we were able to perform radical resection of the liver metastasis by performing hepatectomy twice. In October 2013, anal pain appeared and a painful tumor approximately 2 cm in size was found in the 5 o'clock direction of the anus. Biopsy revealed a well-differentiated tubular adenocarcinoma similar to rectal cancer, and it was diagnosed as a fistula metastasis of rectal cancer. We performed chemoradiotherapy(S-1 120 mg/day plus RT 60 Gy/30 Fr)as surgery was recommended but refused. As a result, the tumor reduced markedly in size. In December 2015, the tumor enlarged in size and the patient and family requested surgery. We, therefore, performed abdominoperineal resection. Currently, the patient is alive at 18 months after surgery with no recurrence.
要旨
症例は58歳,男性。2009年8月,直腸癌肝肺転移に対して直腸切除術(D2郭清)を施行した。病理組織学的所見はRa,2型,70×80 mm,tub1>tub2,int,pSI(peritoneum),INF b,ly1,v1,pN1(2/13),pPM0,pDM0,M1a(H1,PUL1),fStageⅣであった。術後化学療法を施行したところ,胸部CT検査上,肺転移は消失したため,二度にわたる肝切除を施行し根治切除が得られた。2013年10月に肛門痛が出現し,肛門5時方向に疼痛を伴う約2 cm大の腫瘍を認めた。生検にて直腸癌と類似の高分化型管状腺癌を認め,直腸癌の痔瘻転移と診断した。手術を勧めたが希望せず,化学放射線療法(S-1 120 mg/day+RT 60 Gy/30 Fr)を施行し,腫瘍は著明に縮小した。2015年12月に腫瘍が再増大し,腹会陰式直腸切断術を施行した。現在,術後18か月無再発生存中である。
目次
Summary
A 58-year-old man underwent rectal resection(D2 dissection)for rectal cancer and liver/lung metastases in August 2009. Histopathological findings were Ra, type 2, 70×80 mm, tub1>tub2, int, pSI(peritoneum), INF b, ly1, v1, pN1(2/13), pPM0, pDM0, M1a(H1, PUL1), fStageⅣ. The lung metastasis had disappeared on chest CT after postoperative chemotherapy and we were able to perform radical resection of the liver metastasis by performing hepatectomy twice. In October 2013, anal pain appeared and a painful tumor approximately 2 cm in size was found in the 5 o'clock direction of the anus. Biopsy revealed a well-differentiated tubular adenocarcinoma similar to rectal cancer, and it was diagnosed as a fistula metastasis of rectal cancer. We performed chemoradiotherapy(S-1 120 mg/day plus RT 60 Gy/30 Fr)as surgery was recommended but refused. As a result, the tumor reduced markedly in size. In December 2015, the tumor enlarged in size and the patient and family requested surgery. We, therefore, performed abdominoperineal resection. Currently, the patient is alive at 18 months after surgery with no recurrence.
要旨
症例は58歳,男性。2009年8月,直腸癌肝肺転移に対して直腸切除術(D2郭清)を施行した。病理組織学的所見はRa,2型,70×80 mm,tub1>tub2,int,pSI(peritoneum),INF b,ly1,v1,pN1(2/13),pPM0,pDM0,M1a(H1,PUL1),fStageⅣであった。術後化学療法を施行したところ,胸部CT検査上,肺転移は消失したため,二度にわたる肝切除を施行し根治切除が得られた。2013年10月に肛門痛が出現し,肛門5時方向に疼痛を伴う約2 cm大の腫瘍を認めた。生検にて直腸癌と類似の高分化型管状腺癌を認め,直腸癌の痔瘻転移と診断した。手術を勧めたが希望せず,化学放射線療法(S-1 120 mg/day+RT 60 Gy/30 Fr)を施行し,腫瘍は著明に縮小した。2015年12月に腫瘍が再増大し,腹会陰式直腸切断術を施行した。現在,術後18か月無再発生存中である。