Journal Article 計画的に外科切除し得た乳癌・直腸癌の同時性重複癌の1例
A case of synchronous double cancer of the breast and rectum being surgically resected in a planned way
ケイカクテキ ニ ゲカ セツジョ シエタ ニュウガン チョクチョウガン ノ ドウジセイ チョウフクガン ノ 1レイ

久保, 秀文  ,  木村, 祐太  ,  河岡, 徹  ,  宮原, 誠  ,  清水, 良一  ,  植木谷, 俊之  ,  片山, 節

66 ( 3 )  , pp.183 - 190 , 2017-08-01 , 山口大学医学会
今回われわれは乳癌と直腸癌の同時性重複癌の1例を経験した.症例は67歳女性,約1年前より左乳房内の小硬結を自覚していたが,血便で当院内科を受診した.肛門縁より約2cmの部位に2型病変が認められ組織診にてgroup3であった.MMG,USで左乳房D領域に約3cm大の腫瘤が認められ,針生検にて硬癌であった.PET/CTで左内腸骨動脈周囲や直腸左背側のリンパ節に腫大と異常集積があり,直腸癌の主リンパ節への転移が疑われた.以上より左乳癌:T2N0M0;StageIIA,直腸癌:T2(MP)~T3(A)N3M0~1;c StageIIIb~Ⅳと術前診断され,Bp+SLN+S状結腸人工肛門造設術を施行した.術後SOX3コースと骨盤腔へRT50Gyを行い治療効果はPRであった.その4週間後に直腸切断術+D3郭清施行した.以後左残存乳房へのRT50Gyを行った後,3コースのSOXを追加した.さらにその後DTX+ハーセプチンを投与中であるが,再発はなく健在である.同時性重複癌においては各癌腫の進行度,患者のQOLやADL,手術時期,各抗癌剤の副作用などに配慮し,効率良く各癌腫の根治を行う必要がある.
We experienced a case of synchronous double cancer of the breast and rectum. A 67-years old woman had melena and visited to internal medicine of our hospital. She also had been noticed a left small breast mass since last year. Endoscopic examination of the colon demonstrated a type 2 cancer in 2cm from the anal verge. Cytology of the tumor was diagnosed in group 3. The tumor was 3cm and observed at D region in left breast by mammography and breast ultrasound. Needle biopsy demonstrated as scirrhous carcinoma in histologically.PET/CT showed abnormal accumulations and swellings of lymph nodes around internal iliac artery and left dorsal lesion of the rectum. PET showed a slight accumulation in left adrenal gland which couldn't be denied the possibility of a metastasis. Therefore, we diagnosed synchronous double cancer of the breast and rectum. We performed partial mastectomy with sentinel lymph node biopsy and sigmoid colostomy. Subsequently, she had been treated in neoadjuvant chemotherapy and radiation therapy to rectal cancer. The tumor and lymph nodes were remarkably decreased, and the evaluation of treatment was partial response. One month later, rectal amputation was performed. After that, we performed the radiation therapy to left residual mammary glands. She had also received in adjuvant chemotherapy, and she is alive without recurrence. In a case of synchronous double cancer, we should make a radical treatment plan for both cancers by taking into account of tumor progression, QOL, ADL, timing for an operation, and side effects of chemotherapy, respectively.

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