漿膜浸潤および第3群リンパ節転移を呈した直径13mmの0-IIa＋IIc型S状結腸癌の１例

概要

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A 73-year-old man was admitted to our hospital for screening for colonic malignancy. Colonoscopy　revealed a 0-IIa＋IIc typed lesion,13mm in diameter,in the sigmoid colon.Endscopic ultrasonograpy (EUS)　was performed, and we suspected that the tumor had invaded the submucosal layer massively or the proper muscle layer. Pathological examination of the biopsy specimens showed a moderately or poorly-differentiated adenocarcinoma. We performed laparoscopic surgery; however, serosal invasion of the tumor was detected in the sigmoid colon. Furthermore,a metastatic lymph node around the inferior mesentric artery was detected. Consequently, we performed a laparotomy, and then performed sigmoidectomy and regional lymph node dissection (D3). Pathology revealed a poorly-differentiated adenocarcinoma. When we retrospectively compared an image of the histological specimen with the EUS pictures, it was revealed that the tumor cells had invaded the proper muscle sparsely, but had massively developed on the serosa. Because the proper muscle layer appeared to be in good condition in the EUS pictures, it was difficult to make a precise diagnosis of the tumor invasion. Although the advanced sigmoid colon carcinoma was 2cm or less in size, it invaded beyond the serosa with lymph node metastasis because the histological type was a poorly-differentiated adenocarcinoma.
信州医学会の論文