内容紹介
Summary
A 56-year-old man was admitted to our hospital because abdominal CT showed wall thickening of the ascending colon. Colonoscopy showed type 4 colon cancer, diagnosed as poorly differentiated adenocarcinoma by biopsy, with circumferential stenosis. Enhanced CT after admission also showed obstructive ileus and lymphadenopathy leading to a paraaortic lesion, but no other distant metastases were seen. Right hemicolectomy was performed. Histological examination showed poorly differentiated adenocarcinoma extending from the hepatic flexure to the terminal ileum, with marked invaded vessels and stromal fibrosis, which was diagnosed as type 4 colon cancer of scirrhous and lymphangiosis types. On the 10th postoperative day, he developed lymphangitis carcinomatosa. Intensive treatment including steroid therapy was not effective, and he died of respiratory failure on the 26th day. Type 4 colon cancer is rare and has very poor prognosis. We report a case and literature review.
要旨
症例は56歳,男性。検診のCTで上行結腸の壁肥厚を認め,当科に紹介となった。下部消化管内視鏡検査で上行結腸に全周性狭窄を伴う4型腫瘍を認め,生検で低分化型腺癌が検出された。入院後の造影CTでは閉塞性イレウスと傍大動脈領域に至るまでのリンパ節腫大を認めたが,その他遠隔転移は認めなかった。右半結腸切除術を施行した。病理組織学的検査では,回腸末端から肝弯曲上行結腸までの広範囲に著明な脈管侵襲と間質の線維化を伴う低分化型腺癌の浸潤を認め,scirrhous型とlymphangiosis型の二つの特徴を示す4型大腸癌と診断した。術後第10病日に癌性リンパ管症を発症し,ステロイドパルス療法を含む集約治療を行ったが第26病日に呼吸不全のため死亡した。びまん浸潤型大腸癌はまれでかつ予後不良な疾患であり,発症から急速な転帰をたどった本症例を文献的考察を交え報告する。
目次
A 56-year-old man was admitted to our hospital because abdominal CT showed wall thickening of the ascending colon. Colonoscopy showed type 4 colon cancer, diagnosed as poorly differentiated adenocarcinoma by biopsy, with circumferential stenosis. Enhanced CT after admission also showed obstructive ileus and lymphadenopathy leading to a paraaortic lesion, but no other distant metastases were seen. Right hemicolectomy was performed. Histological examination showed poorly differentiated adenocarcinoma extending from the hepatic flexure to the terminal ileum, with marked invaded vessels and stromal fibrosis, which was diagnosed as type 4 colon cancer of scirrhous and lymphangiosis types. On the 10th postoperative day, he developed lymphangitis carcinomatosa. Intensive treatment including steroid therapy was not effective, and he died of respiratory failure on the 26th day. Type 4 colon cancer is rare and has very poor prognosis. We report a case and literature review.
要旨
症例は56歳,男性。検診のCTで上行結腸の壁肥厚を認め,当科に紹介となった。下部消化管内視鏡検査で上行結腸に全周性狭窄を伴う4型腫瘍を認め,生検で低分化型腺癌が検出された。入院後の造影CTでは閉塞性イレウスと傍大動脈領域に至るまでのリンパ節腫大を認めたが,その他遠隔転移は認めなかった。右半結腸切除術を施行した。病理組織学的検査では,回腸末端から肝弯曲上行結腸までの広範囲に著明な脈管侵襲と間質の線維化を伴う低分化型腺癌の浸潤を認め,scirrhous型とlymphangiosis型の二つの特徴を示す4型大腸癌と診断した。術後第10病日に癌性リンパ管症を発症し,ステロイドパルス療法を含む集約治療を行ったが第26病日に呼吸不全のため死亡した。びまん浸潤型大腸癌はまれでかつ予後不良な疾患であり,発症から急速な転帰をたどった本症例を文献的考察を交え報告する。