Journal Article 術後8年以上経過して多発肝転移を来したS状結腸SM癌の1例
A case of multiple liver metastases over 8 years after excision of sigmoid colon cancer with submucosal invasion
ジュツゴ 8ネン イジョウ ケイカ シテ タハツ カン テンイ オ キタシタ Sジョウ ケッチョウ SMガン ノ 1レイ

久保, 秀文  ,  木村, 祐太  ,  河岡, 徹  ,  宮原, 誠  ,  清水, 良一  ,  桑代, 紳哉  ,  山下, 吉美

66 ( 2 )  , pp.129 - 134 , 2017-05-01 , 山口大学医学会
症例は68歳,男性2007年12月にS状結腸早期癌(IIa+IIc type)に対し腹腔鏡下結腸切除+D2郭清を施行された.病理組織では中分化型腺癌,SM, ly1,v0,n0で根治度Aであった.2016年2月に検診USで多発性の肝腫瘍病変を指摘され精査加療目的で入院となった.経皮的な肝腫瘍生検にて腺癌と確定し大腸癌の肝転移が疑われた.ベバシズマブ+SOX療法を5コース投与したところ,CTで肝転移病巣は消失し,PETでの異常集積も消失し腫瘍マーカーは著明に低下した.現在S-1単独内服にて経過観察中である.大腸SM癌の5年以上経過しての肝転移はごくまれではあるが存在するため,さらなる症例の蓄積を行い,再発危険因子の解明とサーベイランスの確立が必要である.
The patient was a 68-year-old man who was underwent laparoscopic resection with D2 lymph node dissection for the early sigmoid colon cancer(IIa+IIc type)in December 2007.The pathological diagnosis was moderate-differentiated adenocarcinoma with invasion to submucosa(SM),slight lymphatic invasion(ly1)and no venous invasion(v0)in the colonic wall and no lymphoid metastases(n0),which were categorized in curative A resection.In February 2016, an abdominal ultra-sonography detected multiple tumorous lesions of the liver. As pathological examinations of percutaneous liver biopsy demonstrated the same pathological image as the primary sigmoid colon cancer, they were diagnosed as hepatic metastases. Six courses of bevacizumab and SOX were administered and these lesions disappeared. After that, S-1 only was performed for this patient and his disease remained stable and no new metastasis has occurred. Rarely but liver metastases from the SM colon cancer can occur. So it is necessary to accumulate more cases to elucidate the risk factors for recurrence and establish a surveillance system.

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