内容紹介
A Case of Concurrent Cancer in a Giant Rectal Villous Adenoma That Resulted in Extensive Lymph Node Metastases
Summary
The patient was a 72-year-old man. Colonoscopy revealed a circumferential villous tumor with granular aggregates extending from the rectosigmoid(RS)to the lower rectum(Rb). Although most portions were indicative of a villous adenoma, a reddish coarse region at the upper rectum(Ra)was diagnosed as a concurrent adenocarcinoma based on biopsies. Consequently, we performed laparoscopy-assisted intersphincteric resection(ISR)and D3 lymph node dissection. Pathological diagnosis revealed multiple lymph node(LN)metastases, including ones at the root of the inferior mesenteric artery(IMA). Adjuvant chemotherapy was administered with XELOX. However, computed tomography(CT)and positron emission tomography(PET)conducted 6 months after surgery revealed recurrent LN metastasis in the mesosigmoid ie, extra-regional LN metastasis. Therefore, chemotherapy was reinitiated with a FOLFIRI-based regimen. Metastases were observed in the lateral LNs and the para-aortic LNs 9 months after surgery, and in the left supraclavicular LNs 12 months after surgery. Herein, we report a rare case of cancer concurrent with a giant villous adenoma, which resulted in extensive LN metastases.
要旨
症例は72歳,男性。下部消化管内視鏡検査にて,直腸S状部(RS)から下部直腸(Rb)にかけて顆粒状隆起が集簇した全周性の絨毛病変を認めた。また,その中央部の赤色調粗大結節には腺癌の合併を認めた。腹腔鏡補助下括約筋間直腸切除術(ISR)+D3郭清を施行し,病理診断では主リンパ節も含めた多発リンパ節転移を認めた。XELOXによる補助化学療法を施行したが,術後6か月目のCT・PET検査にて領域外となるS状結腸間膜内のリンパ節に転移再発を認め,新たにFOLFIRIベースの化学療法を開始した。術後9か月目には大動脈周囲・側方リンパ節に,11か月目には左鎖骨上リンパ節にも転移を認めた。今回われわれは,巨大絨毛腺腫の一部に癌を合併し広範なリンパ節転移を来したまれな症例を経験したので報告する。
目次
Summary
The patient was a 72-year-old man. Colonoscopy revealed a circumferential villous tumor with granular aggregates extending from the rectosigmoid(RS)to the lower rectum(Rb). Although most portions were indicative of a villous adenoma, a reddish coarse region at the upper rectum(Ra)was diagnosed as a concurrent adenocarcinoma based on biopsies. Consequently, we performed laparoscopy-assisted intersphincteric resection(ISR)and D3 lymph node dissection. Pathological diagnosis revealed multiple lymph node(LN)metastases, including ones at the root of the inferior mesenteric artery(IMA). Adjuvant chemotherapy was administered with XELOX. However, computed tomography(CT)and positron emission tomography(PET)conducted 6 months after surgery revealed recurrent LN metastasis in the mesosigmoid ie, extra-regional LN metastasis. Therefore, chemotherapy was reinitiated with a FOLFIRI-based regimen. Metastases were observed in the lateral LNs and the para-aortic LNs 9 months after surgery, and in the left supraclavicular LNs 12 months after surgery. Herein, we report a rare case of cancer concurrent with a giant villous adenoma, which resulted in extensive LN metastases.
要旨
症例は72歳,男性。下部消化管内視鏡検査にて,直腸S状部(RS)から下部直腸(Rb)にかけて顆粒状隆起が集簇した全周性の絨毛病変を認めた。また,その中央部の赤色調粗大結節には腺癌の合併を認めた。腹腔鏡補助下括約筋間直腸切除術(ISR)+D3郭清を施行し,病理診断では主リンパ節も含めた多発リンパ節転移を認めた。XELOXによる補助化学療法を施行したが,術後6か月目のCT・PET検査にて領域外となるS状結腸間膜内のリンパ節に転移再発を認め,新たにFOLFIRIベースの化学療法を開始した。術後9か月目には大動脈周囲・側方リンパ節に,11か月目には左鎖骨上リンパ節にも転移を認めた。今回われわれは,巨大絨毛腺腫の一部に癌を合併し広範なリンパ節転移を来したまれな症例を経験したので報告する。