内容紹介
Summary
The patient was a man in his 70s who visited our hospital to undergo an examination for fecal occult blood, which detected a 20 mm, Ⅱa lesion in the lower rectum on colonoscopy. He was diagnosed with SM-invasive cancer and was planned to undergo trans-anal local excision. After the surgery, he had a good postoperative course without complications. The pathological findings were Ⅱa, tub1, 22×16 mm, pT1a(950 μm), int, INF a, ly0, v0, pHM0, pVM0(300 μm). He was followed up after the surgery, but was diagnosed with lateral lymph node recurrence 4 years after a local surgery. The surgery involved right-sided lateral lymphadenectomy with resection of the ureter, spermatic duct, seminal vesicle, and piriformis muscle. He was diagnosed with lymph node metastasis with invasion of the spermatic duct based on pathology. Eight courses of adjuvant chemotherapy containing CapeOX was administered. Unfortunately, primary squamous cell lung cancer was detected, and he died after surgery for recurrence in the second year. It is suggested that it is necessary to note lateral lymph node recurrence on postoperative follow-up for lower rectal cancer at any stage.
要旨
症例は70歳台,男性。便潜血陽性精査目的で当院を紹介受診し,大腸内視鏡検査にて下部直腸に20 mm大のⅡa病変を認め,SM浸潤癌を疑い経肛門的局所切除の方針となった。病理組織検査はⅡa,tub1,22×16 mm,pT1a(950 μm),ly0,v0,pHM0,pVM0(300 μm)であった。以後外来にてfollowしていたが,術後4年目のCTにて右側方リンパ節(#263D)に腫大を認め,PETにて同部位にSUVmax 3.17の集積を認めたため側方リンパ節再発と診断し,切除の方針となった。開腹右側方リンパ節切除を施行した。尿管,精管・精囊,梨状筋に浸潤を疑う所見あり,合併切除した。病理組織検査では精管外膜への浸潤を認め,リンパ節転移の診断であった。術後再発を認めなかったが原発性肺癌(SCC)を罹患し,再発手術後2年目で他病死した。側方リンパ節は下部直腸領域においてセンチネルリンパ節となる症例もあり,下部直腸癌に対する再発サーベイランスにおいて,早期癌に対しても側方リンパ節再発に留意する必要があることが示唆された。
目次
The patient was a man in his 70s who visited our hospital to undergo an examination for fecal occult blood, which detected a 20 mm, Ⅱa lesion in the lower rectum on colonoscopy. He was diagnosed with SM-invasive cancer and was planned to undergo trans-anal local excision. After the surgery, he had a good postoperative course without complications. The pathological findings were Ⅱa, tub1, 22×16 mm, pT1a(950 μm), int, INF a, ly0, v0, pHM0, pVM0(300 μm). He was followed up after the surgery, but was diagnosed with lateral lymph node recurrence 4 years after a local surgery. The surgery involved right-sided lateral lymphadenectomy with resection of the ureter, spermatic duct, seminal vesicle, and piriformis muscle. He was diagnosed with lymph node metastasis with invasion of the spermatic duct based on pathology. Eight courses of adjuvant chemotherapy containing CapeOX was administered. Unfortunately, primary squamous cell lung cancer was detected, and he died after surgery for recurrence in the second year. It is suggested that it is necessary to note lateral lymph node recurrence on postoperative follow-up for lower rectal cancer at any stage.
要旨
症例は70歳台,男性。便潜血陽性精査目的で当院を紹介受診し,大腸内視鏡検査にて下部直腸に20 mm大のⅡa病変を認め,SM浸潤癌を疑い経肛門的局所切除の方針となった。病理組織検査はⅡa,tub1,22×16 mm,pT1a(950 μm),ly0,v0,pHM0,pVM0(300 μm)であった。以後外来にてfollowしていたが,術後4年目のCTにて右側方リンパ節(#263D)に腫大を認め,PETにて同部位にSUVmax 3.17の集積を認めたため側方リンパ節再発と診断し,切除の方針となった。開腹右側方リンパ節切除を施行した。尿管,精管・精囊,梨状筋に浸潤を疑う所見あり,合併切除した。病理組織検査では精管外膜への浸潤を認め,リンパ節転移の診断であった。術後再発を認めなかったが原発性肺癌(SCC)を罹患し,再発手術後2年目で他病死した。側方リンパ節は下部直腸領域においてセンチネルリンパ節となる症例もあり,下部直腸癌に対する再発サーベイランスにおいて,早期癌に対しても側方リンパ節再発に留意する必要があることが示唆された。