内容紹介
A Case of Synchronous Sigmoid Cancer and Ureter Cancer
Summary
A 78-year-old-man visited a nearby doctor for treatment of hepatitis C and high blood pressure. He was diagnosed with right hydronephrosis by abdominal echography conducted in follow-up of hepatitis C treatment in November 2011; he was then introduced to our hospital for close inspection and medical treatment. We observed wall hyperplasia and narrowing of the lumen in the central sigmoid part by contrast-enhanced computed tomography(CT). The right ureter at the L4/5 level showed wall hyperplasia and a deep color, and the right ureter, renal pelvis, and calix were expanded on the head side. By examination for CF, we observed a type 2 lesion in the sigmoid colon, and a biopsy showed well-differentiated adenocarcinoma. Based upon these findings, he was diagnosed with synchronous sigmoid colon cancer(cT4aN0M0, cStageⅡ)and ureter cancer(cT2N0M0, cStageⅡ); we performed laparotomy sigmoidectomy(D3 dissection)and full extraction of the right kidney urinary tract(lymph node dissection in front of the vena cava, the latter outside and between the aorta and vena cava). The postoperative course was particularly uneventful, and the patient was discharged from the hospital on day 38 after the operation. More than 2 years after the surgery, the patient exhibits no sign of sigmoid colon cancer or ureter cancer recurrence.
要旨
症例は78歳,男性。C型肝炎,高血圧症で近医通院中であった。C型肝炎のfollow目的で施行された腹部エコーにて右水腎症の指摘あり,精査加療目的に2011年11月当院を紹介された。造影CT検査にてS状結腸中部に壁肥厚と内腔の狭窄化があり,右尿管はL4/5レベルで壁肥厚・濃染を認め,その頭側では尿管・腎盂・腎杯が著明に拡張していた。大腸内視鏡(CF)検査ではS状結腸に2型病変を認め,生検で高分化型腺癌と診断された。以上のことからS状結腸癌(cT4aN0M0,cStageⅡ)・画像所見より尿管癌(cT2N0M0,cStageⅡ)と診断し,S状結腸切除術(D3郭清術)+右腎尿管全摘術(大静脈前・後・外側,大動静脈間リンパ節郭清)を施行した。術後経過は特に問題なく,術後2年経過しているが,S状結腸癌・尿管癌のいずれも再発兆候を認めていない。
目次
Summary
A 78-year-old-man visited a nearby doctor for treatment of hepatitis C and high blood pressure. He was diagnosed with right hydronephrosis by abdominal echography conducted in follow-up of hepatitis C treatment in November 2011; he was then introduced to our hospital for close inspection and medical treatment. We observed wall hyperplasia and narrowing of the lumen in the central sigmoid part by contrast-enhanced computed tomography(CT). The right ureter at the L4/5 level showed wall hyperplasia and a deep color, and the right ureter, renal pelvis, and calix were expanded on the head side. By examination for CF, we observed a type 2 lesion in the sigmoid colon, and a biopsy showed well-differentiated adenocarcinoma. Based upon these findings, he was diagnosed with synchronous sigmoid colon cancer(cT4aN0M0, cStageⅡ)and ureter cancer(cT2N0M0, cStageⅡ); we performed laparotomy sigmoidectomy(D3 dissection)and full extraction of the right kidney urinary tract(lymph node dissection in front of the vena cava, the latter outside and between the aorta and vena cava). The postoperative course was particularly uneventful, and the patient was discharged from the hospital on day 38 after the operation. More than 2 years after the surgery, the patient exhibits no sign of sigmoid colon cancer or ureter cancer recurrence.
要旨
症例は78歳,男性。C型肝炎,高血圧症で近医通院中であった。C型肝炎のfollow目的で施行された腹部エコーにて右水腎症の指摘あり,精査加療目的に2011年11月当院を紹介された。造影CT検査にてS状結腸中部に壁肥厚と内腔の狭窄化があり,右尿管はL4/5レベルで壁肥厚・濃染を認め,その頭側では尿管・腎盂・腎杯が著明に拡張していた。大腸内視鏡(CF)検査ではS状結腸に2型病変を認め,生検で高分化型腺癌と診断された。以上のことからS状結腸癌(cT4aN0M0,cStageⅡ)・画像所見より尿管癌(cT2N0M0,cStageⅡ)と診断し,S状結腸切除術(D3郭清術)+右腎尿管全摘術(大静脈前・後・外側,大動静脈間リンパ節郭清)を施行した。術後経過は特に問題なく,術後2年経過しているが,S状結腸癌・尿管癌のいずれも再発兆候を認めていない。