内容紹介
Summary
A woman in her 50s was admitted to our hospital with fever and lower abdominal swelling. Abdominal CT/MRI examinations revealed irregular thickening of the transverse colon wall, which was attached to a subcutaneous abscess. An abdominal wall mass, a patent urachus, and a tumor in the 5th segment of the liver were also noted. Colonoscopy revealed type 2 advanced transverse colon cancer. The solitary, sessile tumor was observed at the apex of the bladder under cystoscopy, suggesting the formation of the urachal carcinoma. Transcutaneous liver biopsy obtained from the liver tumor indicated adenocarcinoma, which was morphologically different from the existing transverse colon cancer. Right hemicolectomy with resection of the umbilicus, abdominal wall, urachus, and part of the bladder wall was performed. Diagnosis of the transverse colon cancer invading the abdominal wall and bladder was confirmed by histopathological examination. Hepatectomy was performed in the next surgery, and the tumor was histopathologically diagnosed as an intrahepatic cholangiocarcinoma. Both the transverse colon cancer and the intrahepatic cholangiocarcinoma were radically resected. Radical surgical diagnostic resection may be valuable in cases of multicentric cancers of unknown primary origin, if radical resection of each individual tumor is required.
要旨
患者は50歳台,女性。発熱および臍下の腫脹を主訴に受診した。腹部CT/MRI検査で皮下膿瘍に連続する横行結腸の不整な壁肥厚・腹壁腫瘤および尿膜管の開存を疑う所見,肝S5に腫瘤形成を認めた。下部消化管内視鏡検査で横行結腸に2型病変を認め,中分化腺癌の診断であった。膀胱鏡検査で膀胱頂部に単発性広基性腫瘍を認め,尿膜管癌の合併を疑った。経皮的肝生検にて前述の横行結腸癌と細胞形態の異なる腺癌の診断を得た。診断的治療目的に結腸右半切除・腹壁・膀胱部分切除を施行し,病理組織結果で横行結腸癌・腹壁浸潤・膀胱浸潤の診断を得た。二期的に肝切除を施行し肝内胆管癌の診断を得た。いずれも根治切除となった。本症例では横行結腸癌と肝内胆管癌の重複癌であった。原発部位診断に苦慮する重複癌と考えられる症例では各々に外科的切除による根治の可能性があれば診断的治療を兼ねた切除は有効と思われた。
目次
A woman in her 50s was admitted to our hospital with fever and lower abdominal swelling. Abdominal CT/MRI examinations revealed irregular thickening of the transverse colon wall, which was attached to a subcutaneous abscess. An abdominal wall mass, a patent urachus, and a tumor in the 5th segment of the liver were also noted. Colonoscopy revealed type 2 advanced transverse colon cancer. The solitary, sessile tumor was observed at the apex of the bladder under cystoscopy, suggesting the formation of the urachal carcinoma. Transcutaneous liver biopsy obtained from the liver tumor indicated adenocarcinoma, which was morphologically different from the existing transverse colon cancer. Right hemicolectomy with resection of the umbilicus, abdominal wall, urachus, and part of the bladder wall was performed. Diagnosis of the transverse colon cancer invading the abdominal wall and bladder was confirmed by histopathological examination. Hepatectomy was performed in the next surgery, and the tumor was histopathologically diagnosed as an intrahepatic cholangiocarcinoma. Both the transverse colon cancer and the intrahepatic cholangiocarcinoma were radically resected. Radical surgical diagnostic resection may be valuable in cases of multicentric cancers of unknown primary origin, if radical resection of each individual tumor is required.
要旨
患者は50歳台,女性。発熱および臍下の腫脹を主訴に受診した。腹部CT/MRI検査で皮下膿瘍に連続する横行結腸の不整な壁肥厚・腹壁腫瘤および尿膜管の開存を疑う所見,肝S5に腫瘤形成を認めた。下部消化管内視鏡検査で横行結腸に2型病変を認め,中分化腺癌の診断であった。膀胱鏡検査で膀胱頂部に単発性広基性腫瘍を認め,尿膜管癌の合併を疑った。経皮的肝生検にて前述の横行結腸癌と細胞形態の異なる腺癌の診断を得た。診断的治療目的に結腸右半切除・腹壁・膀胱部分切除を施行し,病理組織結果で横行結腸癌・腹壁浸潤・膀胱浸潤の診断を得た。二期的に肝切除を施行し肝内胆管癌の診断を得た。いずれも根治切除となった。本症例では横行結腸癌と肝内胆管癌の重複癌であった。原発部位診断に苦慮する重複癌と考えられる症例では各々に外科的切除による根治の可能性があれば診断的治療を兼ねた切除は有効と思われた。