内容紹介
Summary
A 74-year-old woman was found to have a hepatic mass based on CT findings. She was diagnosed as having cecum cancer, and it was difficult to distinguish whether the hepatic mass was liver metastasis or biliary cystadenocarcinoma. We proceeded with the surgery for cecum cancer, and laparoscopic ileocecal resection with D3 lymph node dissection was performed. The histopathological diagnosis was mucinous adenocarcinoma, and the pathological stage was T3N2H1P0M1a, Stage Ⅳ. After the surgery, her CEA level was elevated, and we diagnosed the hepatic mass as a liver metastasis. A CapeOX plus bevacizumab regimen was administered but was discontinued for 2 courses due to the development of adverse effects and her decision. Gd-EOB-DTPA-enhanced MRI revealed a multilocular and lobulated mass, which was a low-intensity area in T1WI and high-intensity area in T2WI, and the mass had no significant contrast effects. These images were unspecific for liver metastasis of colorectal cancer, and we performed segmental 6 hepatectomy for diagnosis and curative surgery. A histopathological diagnosis of liver metastasis of cecum cancer was made. Here, we report a case of liver metastasis of colorectal cancer that was undifferentiated from biliary cystadenocarcinoma.
要旨
症例は74歳,女性。検診のCTで肝腫瘤を指摘された。精査の結果,盲腸癌を認め,肝腫瘤は肝転移と肝囊胞腺癌の鑑別が困難であった。原発巣に対する手術を先行する方針とし,腹腔鏡下回盲部切除術を施行した。病理診断で主組織型は粘液癌であり,病期はT3N2H1P0M1a,Stage Ⅳであった。CEA上昇もあり,肝転移と考えCapeOX+bevacizumab療法を開始したが,Grade 2の有害事象を認め本人の希望により2コースで中止した。Gd-EOB-DTPA造影MRIでは,腫瘍はT1WI低信号,T2WI高信号の多房性分葉状の形態を示し,有意な造影増強効果はなかった。大腸癌肝転移としては非典型的な所見であり,診断加療目的に肝S6部分切除を施行した。病理の結果,原発巣と同様に粘液癌主体であり,大腸癌肝転移と診断した。今回われわれは,肝囊胞腺癌との鑑別に難渋した大腸癌肝転移の1例を経験したので報告する。
目次
A 74-year-old woman was found to have a hepatic mass based on CT findings. She was diagnosed as having cecum cancer, and it was difficult to distinguish whether the hepatic mass was liver metastasis or biliary cystadenocarcinoma. We proceeded with the surgery for cecum cancer, and laparoscopic ileocecal resection with D3 lymph node dissection was performed. The histopathological diagnosis was mucinous adenocarcinoma, and the pathological stage was T3N2H1P0M1a, Stage Ⅳ. After the surgery, her CEA level was elevated, and we diagnosed the hepatic mass as a liver metastasis. A CapeOX plus bevacizumab regimen was administered but was discontinued for 2 courses due to the development of adverse effects and her decision. Gd-EOB-DTPA-enhanced MRI revealed a multilocular and lobulated mass, which was a low-intensity area in T1WI and high-intensity area in T2WI, and the mass had no significant contrast effects. These images were unspecific for liver metastasis of colorectal cancer, and we performed segmental 6 hepatectomy for diagnosis and curative surgery. A histopathological diagnosis of liver metastasis of cecum cancer was made. Here, we report a case of liver metastasis of colorectal cancer that was undifferentiated from biliary cystadenocarcinoma.
要旨
症例は74歳,女性。検診のCTで肝腫瘤を指摘された。精査の結果,盲腸癌を認め,肝腫瘤は肝転移と肝囊胞腺癌の鑑別が困難であった。原発巣に対する手術を先行する方針とし,腹腔鏡下回盲部切除術を施行した。病理診断で主組織型は粘液癌であり,病期はT3N2H1P0M1a,Stage Ⅳであった。CEA上昇もあり,肝転移と考えCapeOX+bevacizumab療法を開始したが,Grade 2の有害事象を認め本人の希望により2コースで中止した。Gd-EOB-DTPA造影MRIでは,腫瘍はT1WI低信号,T2WI高信号の多房性分葉状の形態を示し,有意な造影増強効果はなかった。大腸癌肝転移としては非典型的な所見であり,診断加療目的に肝S6部分切除を施行した。病理の結果,原発巣と同様に粘液癌主体であり,大腸癌肝転移と診断した。今回われわれは,肝囊胞腺癌との鑑別に難渋した大腸癌肝転移の1例を経験したので報告する。