胃と腸57巻6号

2022年05月発行

今月の主題 原発性小腸癌—見えてきたその全貌

主題症例

家族性大腸腺腫症における空・回腸癌の4例

著者： 伊藤徹哉¹ 石田秀行¹

所属機関： ¹埼玉医科大学総合医療センター消化管・一般外科

ページ範囲：P.829 - P.836

文献概要

要旨●家族性大腸腺腫症（FAP）は大腸癌ならびに多様な随伴病変を発症する常染色体優性遺伝性疾患であり，頻度は低いものの，空・回腸癌も随伴病変として知られている．当科の151例のFAPのうち空・回腸癌を発症した4例を提示する．内訳は空腸癌が1例，回腸癌が3例であり，回腸癌のうち2例は人工肛門部に発生した．生涯発症リスク（70歳）は15.7%であった．FAPに対する適切な手術治療とサーベイランスの進歩により，若年での大腸癌による死亡が減少することから，今後は空・回腸癌の発生が増加する可能性があり，症例の蓄積による発生メカニズムの解明とサーベイランスの確立が望まれる．

参考文献

1）Bussey HJR. Familial polyposis coli. family studies, histopathology, differential diagnosis, and results of treatment. The Johns Hopkins University press, Baltimore, 1976

2）Iwama T, Tamura K, Morita T, et al. A clinical overview of familial adenomatous polyposis derived from the database of the Polyposis Registry of Japan. Int J Clin Oncol　9：308-316, 2004

3）Spigelman AD, Williams CB, Talbot IC, et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet　2：783-785, 1989

4）大腸癌研究会（編）．遺伝性大腸癌診療ガイドライン2020年版．金原出版，2020

5）Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet　1：1149-1151, 1988

6）Moozar KL, Madlensky L, Berk T, et al. Slow progression of periampullary neoplasia in familial adenomatous polyposis. J Gastrointest Surg　6：831-837, 2002

7）Brosens LAA, Keller JJ, Offerhaus GJ, et al. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut　54：1034-1043, 2005

8）Parc Y, Piquard A, Dozois RR, et al. Long-term outcome of familial adenomatous polyposis patients after restorative coloproctectomy. Ann Surg　239：378-382, 2004

9）Speake D, Evans DG, Lalloo F, et al. Desmoid tumours in patients with familial adenomatous polyposis and desmoid region adenomatous polyposis coli mutations. Br J Surg　94：1009-1013, 2007

10）Saito Y, Hinoi T, Ueno H, et al. Risk factors for the development of desmoid tumor after colectomy in patients with familial adenomatous polyposis：multicenter retrospective cohort study in Japan. Ann Surg Oncol　23：559-565, 2016

11）Ruys AT, Alderlieste YA, Gouma DJ, et al. Jejunal cancer in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol　8：731-733, 2010

12）Nagase H, Miyoshi Y, Horii A, et al. Correlation between the location of germ-line mutations in the APC gene and the number of colorectal polyps in familial adenomatous polyposis patients. Cancer Res　52：4055-4057, 1992

13）Davies DR, Armstrong JG, Thakker N, et al. Severe Gardner syndrome in families with mutations restricted to a specific region of the APC gene. Am J Hum Genet　57：1151-1158, 1995

14）Sanchez-Mete L, Stigliano V. Update on small bowel surveillance in hereditary colorectal cancer syndromes. Tumori　105：12-21, 2019

15）Schulz AC, Bojarski C, Buhr HJ, et al. Occurrence of adenomas in the pouch and small intestine of FAP patients after proctocolectomy with ileoanal pouch construction. Int J Colorectal Dis　23：437-441, 2008

16）Iaquinto G, Fornasarig M, Quaia M, et al. Capsule endoscopy is useful and safe for small-bowel surveillance in familial adenomatous polyposis. Gastrointest Endosc　67：61-67, 2008

17）Wong RF, Tuteja AK, Haslem DS, et al. Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis（with video）. Gastrointest Endosc　64：530-537, 2006

18）Matsumoto T, Esaki M, Yanaru-Fujisawa R, et al. Small-intestinal involvement in familial adenomatous polyposis：evaluation by double-balloon endoscopy and intraoperative enteroscopy. Gastrointest Endosc　68：911-919, 2008

19）Schulmann K, Hollerbach S, Kraus K, et al. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol　100：27-37, 2005

20）Thompson-Fawcett MW, Marcus VA, Redston M, et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum　44：347-353, 2001

21）Tonelli F, Ficari F, Bargellini T, et al. Ileal pouch adenomas and carcinomas after restorative proctocolectomy for familial adenomatous polyposis. Dis Colon Rectum　55：322-329, 2012

22）Sakamoto T, Matsuda T, Nakajima T, et al. Clinicopathological features of colorectal polyps：evaluation of the ‘predict, resect and discard' strategies. Colorectal Dis　15：e295-300, 2013

23）Tajika M, Niwa Y, Bhatia V, et al. Risk of ileal pouch neoplasms in patients with familial adenomatous polyposis. World J Gastroenterol　19：6774-6783, 2013

24）Tajika M, Tanaka T, Ishihara M, et al. Long-term outcomes of metachronous neoplasms in the ileal pouch and rectum after surgical treatment in patients with familial adenomatous polyposis. Endosc Int Open　7：E691-698, 2019

25）田近正洋，田中努，平山裕，他．遺伝性腫瘍術後の内視鏡サーベイランス．消内視鏡　31：1324-1330, 2019

26）Iizuka T, Sawada T, Hayakawa K, et al. Successful local excision of ileostomy adenocarcinoma after colectomy for familial adenomatous polyposis：report of a case. Surg Today　32：638-641, 2002

27）Baciewicz F, Sparberg M, Lawrence JB, et al. Adenocarcinoma of an ileostomy site with skin invasion：a case report. Gastroenterology　84：168-170, 1983

28）Bedetti CD, DeRisio VJ. Primary adenocarcinoma arising at an ileostomy site. An unusual complication after colectomy for ulcerative colitis. Dis Colon Rectum　29：572-575, 1986

29）Carey PD, Suvarna SK, Baloch KG, et al. Primary adenocarcinoma in an ileostomy：a late complication of surgery for ulcerative colitis. Surgery　113：712-715, 1993

30）Reissman P, Avroutis O, Cohen DY, et al. Ileostomy-site colonic metaplasia with adenocarcinoma after proctocolectomy for ulcerative colitis. Am J Gastroenterol　92：1932-1933, 1997