内容紹介
Summary
A man in his 70s presented with a chief complaint of bleeding during bowel movements. Subsequent colonoscopy revealed a submucosal tumor-like elevated lesion of approximately 4 cm situated in the sigmoid section of the rectum. EUS-FNAB was performed, and the lesion was identified as mucinous cancer. Based on a diagnosis of rectal cancer(cT4a, cN0, cM0, cStageⅡ), a low anterior resection was performed. Histopathological analysis of the resected specimen revealed a well-differentiated mucinous cancer. The tumor had ruptured the proper muscular layer and was developing in a submucosal tumor-like manner, protruding from the wall within a fibrous capsule. In Japan, only 15 cases of submucosal tumor-like colorectal mucinous cancer have been reported to date. It is rare for such cases to be preoperatively diagnosed as mucinous cancer using EUS-FNAB and then to undergo radical resection.
要旨
症例は70歳台,男性。排便時出血を自覚し,大腸内視鏡検査で直腸S状部に約4 cmの粘膜下腫瘍様の隆起性病変を認め,EUS-FNABを施行し粘液癌と診断された。直腸癌RS,cT4a,cN0,cM0,cStageⅡの診断で低位前方切除術を施行した。病理組織診断では高分化型粘液癌であり,固有筋層は腫瘍により断裂し,線維性被膜を伴って壁外へ突出する粘膜下腫瘍様の発育形態を示していた。粘膜下腫瘍様の大腸粘液癌は本邦で15例の報告があり,術前に内視鏡的生検にて粘液癌と診断し根治切除を行い得た症例は稀少である。
目次
A man in his 70s presented with a chief complaint of bleeding during bowel movements. Subsequent colonoscopy revealed a submucosal tumor-like elevated lesion of approximately 4 cm situated in the sigmoid section of the rectum. EUS-FNAB was performed, and the lesion was identified as mucinous cancer. Based on a diagnosis of rectal cancer(cT4a, cN0, cM0, cStageⅡ), a low anterior resection was performed. Histopathological analysis of the resected specimen revealed a well-differentiated mucinous cancer. The tumor had ruptured the proper muscular layer and was developing in a submucosal tumor-like manner, protruding from the wall within a fibrous capsule. In Japan, only 15 cases of submucosal tumor-like colorectal mucinous cancer have been reported to date. It is rare for such cases to be preoperatively diagnosed as mucinous cancer using EUS-FNAB and then to undergo radical resection.
要旨
症例は70歳台,男性。排便時出血を自覚し,大腸内視鏡検査で直腸S状部に約4 cmの粘膜下腫瘍様の隆起性病変を認め,EUS-FNABを施行し粘液癌と診断された。直腸癌RS,cT4a,cN0,cM0,cStageⅡの診断で低位前方切除術を施行した。病理組織診断では高分化型粘液癌であり,固有筋層は腫瘍により断裂し,線維性被膜を伴って壁外へ突出する粘膜下腫瘍様の発育形態を示していた。粘膜下腫瘍様の大腸粘液癌は本邦で15例の報告があり,術前に内視鏡的生検にて粘液癌と診断し根治切除を行い得た症例は稀少である。