内容紹介
Summary
A 72-year-old man with ascending colon cancer was admitted to our hospital. Right hemicolectomy and lymph node dissection(D3)were performed. The pathological diagnosis was signet-ring cell carcinoma, T4a(SE), N2b, M1a(LYM), Stage Ⅳ, R0, Cur B. Capecitabine was administered after surgery. Subcutaneous bleeding, thrombocytopenia, and a rapid increase in tumor marker levels occurred 9 months after surgery. He had already developed disseminated intravascular coagulation and was admitted to our hospital immediately. CT scan revealed metastasis in the thoracic vertebrae. Bone scintigraphy demonstrated multiple abnormal areas of uptake in the costal bones and the thoracic and lumber vertebrae. We made a final diagnosis of disseminated carcinomatosis of the bone marrow by histopathological examination. Unfortunately, before starting chemotherapy, his general condition deteriorated, and he died 14 days after hospitalization. We present here a case of colon cancer with disseminated carcinomatosis of the bone marrow.
要旨
症例は72歳,男性。上行結腸癌にて当科紹介となり,右半結腸切除術,3群リンパ節郭清を施行した。病理診断は印環細胞癌で,合併切除した回腸間膜内のリンパ節に転移を認めた。T4a(SE),N2b,M1a(LYM),Stage Ⅳ,R0,Cur Bであった。術後はcapecitabine療法を施行した。術後8か月にCEAの軽度上昇を認めたが,CTでは明らかな転移は指摘できなかった。術後9か月目に腫瘍マーカー(CEA/CA19-9)の急上昇,血小板の著明な減少,皮下出血班を認め,播種性血管内凝固症候群(DIC)と診断され,緊急入院となった。CTで胸椎転移を指摘された。骨シンチグラフィでは肋骨,胸腰椎などに多発性の異常集積像を認めた。骨髄生検を施行し,播種性骨髄癌症と診断された。全身状態が不良で化学療法は導入できないままDICが進行したため,診断から14日目に死亡した。急激な経過をたどった大腸癌播種性骨髄癌症の1例を経験した。
目次
A 72-year-old man with ascending colon cancer was admitted to our hospital. Right hemicolectomy and lymph node dissection(D3)were performed. The pathological diagnosis was signet-ring cell carcinoma, T4a(SE), N2b, M1a(LYM), Stage Ⅳ, R0, Cur B. Capecitabine was administered after surgery. Subcutaneous bleeding, thrombocytopenia, and a rapid increase in tumor marker levels occurred 9 months after surgery. He had already developed disseminated intravascular coagulation and was admitted to our hospital immediately. CT scan revealed metastasis in the thoracic vertebrae. Bone scintigraphy demonstrated multiple abnormal areas of uptake in the costal bones and the thoracic and lumber vertebrae. We made a final diagnosis of disseminated carcinomatosis of the bone marrow by histopathological examination. Unfortunately, before starting chemotherapy, his general condition deteriorated, and he died 14 days after hospitalization. We present here a case of colon cancer with disseminated carcinomatosis of the bone marrow.
要旨
症例は72歳,男性。上行結腸癌にて当科紹介となり,右半結腸切除術,3群リンパ節郭清を施行した。病理診断は印環細胞癌で,合併切除した回腸間膜内のリンパ節に転移を認めた。T4a(SE),N2b,M1a(LYM),Stage Ⅳ,R0,Cur Bであった。術後はcapecitabine療法を施行した。術後8か月にCEAの軽度上昇を認めたが,CTでは明らかな転移は指摘できなかった。術後9か月目に腫瘍マーカー(CEA/CA19-9)の急上昇,血小板の著明な減少,皮下出血班を認め,播種性血管内凝固症候群(DIC)と診断され,緊急入院となった。CTで胸椎転移を指摘された。骨シンチグラフィでは肋骨,胸腰椎などに多発性の異常集積像を認めた。骨髄生検を施行し,播種性骨髄癌症と診断された。全身状態が不良で化学療法は導入できないままDICが進行したため,診断から14日目に死亡した。急激な経過をたどった大腸癌播種性骨髄癌症の1例を経験した。