Departmental Bulletin Paper 虫垂癌の播種・転移と診断された癌性腹膜炎の1例(症例報告)

久保, 卓郎  ,  田口, 一也  ,  高橋, 良樹  ,  柳橋, 健  ,  松本, 尚之  ,  藤田, 健司  ,  岡本, 恵子  ,  濱田, 新七  ,  喜多, 伸幸  ,  村上, 節  ,  高橋, 健太郎

30 ( 1 )  , pp.6 - 12 , 2017-01-16 , 滋賀医科大学雑誌編集委員会
A 44 year-old woman, who had the past history of cesarean section and appendectomy, was admitted to our hospital because of constipation and abdominal distension. Plain computed tomography revealed massive ascites, but no mass was detected in the abdomen. Cytolog y of ascites revealed mucin-producing adenocarcinoma. She was diagnosed peritonitis carcinomatosa. Gastric and colon fiber was performed, but no mass was detected. Cytology of the cervix and endometrium of the uterus revealed no malignancy. Ultrasonography and Magnetic resonance imaging detected no mass in the bilateral ovaries. Dynamic computed tomography revealed inflammation around the cecum, and dissemination in the Douglas’ pouch.Laparoscopic surgery was performed, and the multiple disseminated regions were found in the abdomen. However, no tumor was detected and biopsy of the disseminated regions was conducted. Pathology of the dissemination of the mesentry revealed intestinal-type adeno-carcinoma. Immunohistochemically, the antigen expression profile of the adenocarcinoma was positive for cytokeratin 20, cytokeratin 903(34βE2), and MUC-2, but was negative for cytokeratin 7, MUC5AC, and MUC6. The immunohistochemistry suggested that the origin of the adenocarcinoma was colon, but no tumor was detected in the residual colon after appendectomy. Finally, metastasis and dissemination of the appendiceal cancer was suspected.

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