胃と腸47巻8号

2012年07月発行

早期胃癌研究会症例

SMT様の形態を呈した大腸浸潤性微小乳頭癌の1例

著者： 瀧澤初¹ 曽絵里子¹ 中島健¹ 松田尚久¹ 斎藤豊¹ 九嶋亮治²

所属機関： ¹1）国立がん研究センター中央病院消化管内視鏡科 ²2）国立がん研究センター中央病院病理科

ページ範囲：P.1293 - P.1300

要旨　浸潤性微小乳頭癌（invasive micropapillary carcinoma ; IMPC）の組織像を示す原発性早期大腸癌を経験したので報告する．患者は40歳，男性，自覚症状なし．人間ドックで施行された大腸内視鏡検査にて上行結腸に10mmのSMT様の隆起性病変を指摘された．頂部には陥凹を認め，拡大内視鏡では陥凹部においてSM高度浸潤の所見であった．生検で低分化腺癌と診断され，腹腔鏡補助下右半結腸切除術が施行された．組織学的にはリンパ管様の空隙内に微小乳頭状の癌胞巣が存在する特徴的な像を認めた．免疫染色ではEMA（epithelial membrane antigen）が微小乳頭状癌胞巣の管腔側表面で陽性となり，IMPCに特徴的なinside-out patternを呈した．IMPCは高頻度にリンパ管侵襲・リンパ節転移を来す予後不良な癌腫として注目されているが，本症例は術後1年再発を認めていない．

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