内容紹介
Summary
An 81-year old man with a perirectal abscess was referred in May 2017 by another hospital. We observed swelling in the anal region at the 4 o'clock position and performed incisional drainage. Although this alleviated the pain and inflammation in the anal region, the irritation recurred in early June. The patient presented with bloody stools and a low-grade fever since late June. Pelvic magnetic resonance imaging(MRI)confirmed a solid tumor in the center of the lower rectum(Rb), outside of the anal fistula. We surmised this was rectal cancer. Colonoscopy revealed an ulcerative invasive(Grade 3)tumor extending more than halfway around the Rb; a biopsy confirmed a diagnosis of differentiated adenocarcinoma. Surgery was the preferred treatment option; however, as the patient also had the complication of anal fistula, there were concerns that the cancerous cells would contaminate the intraperitoneal area during surgery. We subsequently we decided to construct a colostomy and then start chemoradiotherapy. The patient began radiotherapy in the beginning of August, and received S-1 as a sensitizer. Contrast computed tomography(CT)and MRI at the completion of chemoradiotherapy confirmed that the rectal cancer had reduced in size. We scheduled later surgery, but the patient declined and preferred to continue with S-1. The tumor has continued to decrease in size, with good local control.
要旨
症例は81歳,男性。2017年5月に他院より肛門周囲膿瘍にて紹介された。肛門4時方向に腫脹を認め,切開排膿を施行した。肛門部痛や炎症所見は軽快したが,6月上旬より炎症所見は再上昇した。6月下旬より血便,微熱が出現した。骨盤MRI検査では痔瘻以外に直腸Rb中心に充実性腫瘤を認め,直腸癌が疑われた。大腸内視鏡検査では直腸Rbに半周以上の3型腫瘍を認め,生検で分化型腺癌と診断された。手術が望ましいと考えられたが痔瘻の併発,手術時に癌細胞が腹腔内に汚染される懸念もあり,まずは人工肛門を造設し,その後に化学放射線療法を行う方針となった。8月初旬より放射線療法を開始し,増感剤としてS-1を投与した。化学放射線療法終了後の造影CT検査およびMRI検査にて直腸癌の縮小を認めた。その後手術を予定したが希望せず,S-1の継続とした。その後も腫瘍の縮小を認めており,腫瘍の局所制御は良好と考える。
目次
An 81-year old man with a perirectal abscess was referred in May 2017 by another hospital. We observed swelling in the anal region at the 4 o'clock position and performed incisional drainage. Although this alleviated the pain and inflammation in the anal region, the irritation recurred in early June. The patient presented with bloody stools and a low-grade fever since late June. Pelvic magnetic resonance imaging(MRI)confirmed a solid tumor in the center of the lower rectum(Rb), outside of the anal fistula. We surmised this was rectal cancer. Colonoscopy revealed an ulcerative invasive(Grade 3)tumor extending more than halfway around the Rb; a biopsy confirmed a diagnosis of differentiated adenocarcinoma. Surgery was the preferred treatment option; however, as the patient also had the complication of anal fistula, there were concerns that the cancerous cells would contaminate the intraperitoneal area during surgery. We subsequently we decided to construct a colostomy and then start chemoradiotherapy. The patient began radiotherapy in the beginning of August, and received S-1 as a sensitizer. Contrast computed tomography(CT)and MRI at the completion of chemoradiotherapy confirmed that the rectal cancer had reduced in size. We scheduled later surgery, but the patient declined and preferred to continue with S-1. The tumor has continued to decrease in size, with good local control.
要旨
症例は81歳,男性。2017年5月に他院より肛門周囲膿瘍にて紹介された。肛門4時方向に腫脹を認め,切開排膿を施行した。肛門部痛や炎症所見は軽快したが,6月上旬より炎症所見は再上昇した。6月下旬より血便,微熱が出現した。骨盤MRI検査では痔瘻以外に直腸Rb中心に充実性腫瘤を認め,直腸癌が疑われた。大腸内視鏡検査では直腸Rbに半周以上の3型腫瘍を認め,生検で分化型腺癌と診断された。手術が望ましいと考えられたが痔瘻の併発,手術時に癌細胞が腹腔内に汚染される懸念もあり,まずは人工肛門を造設し,その後に化学放射線療法を行う方針となった。8月初旬より放射線療法を開始し,増感剤としてS-1を投与した。化学放射線療法終了後の造影CT検査およびMRI検査にて直腸癌の縮小を認めた。その後手術を予定したが希望せず,S-1の継続とした。その後も腫瘍の縮小を認めており,腫瘍の局所制御は良好と考える。