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福島医学雑誌 = Fukushima Medical Journal >
Vol.65 (2015) >
No.4 (2015-12) >

Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/1013

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Title: 腹腔鏡が診断・治療に有用であった対照的な虫垂粘液産生腫瘍の2例
Other Titles: Two Cases of Appendieal Mucinous Neoplasm in Which Laparoscopic Surgery Effectively Worked both as a Surgery and Diagnostic Tool
Authors: 坂本, 渉
島貫, 公義
原, 敬介
高, 和英
武田, 幸樹
旭, 修司
竹之下, 誠一
Affiliation: 器官制御外科学講座
Source title: 福島医学雑誌
Volume: 65
Issue: 4
Start page: 192
End page: 199
Issue Date: Dec-2015
Abstract: 虫垂粘液産生腫瘍(Appendiceal mucinous neoplasm:AMN)は比較的まれな疾患で、未だ良・悪性の鑑別は困難であり、術式決定に難渋することも少なくない。今回我々は腹腔鏡の使用により、過大侵襲を回避できたと考えられる対照的なAMNの2例を経験した。症例1は74歳女性。スクリーニングUSで偶然指摘された右下腹部腫瘤。術前CEA高値。AMNの診断で腹腔鏡補助下回盲部切除を施行。病理はLow-grade appendiceal mucinous neoplasmでCEA免疫染色は強陽性であった。症例2は39歳男性。主訴は右下腹部の腫瘤と疼痛。術前CEA、CA19-9高値であったが腹水貯留なし。AMNの診断で腹腔鏡補助下回盲部切除を予定して手術に臨んだが、著しい播種を認めたため審査腹腔鏡にとどまった。手術時に採取した腹水細胞診では核の偏在、PAS染色陽性で粘液を含んだ孤立散在性の細胞を認めるものの核異型が弱くClassIVの診断であった。過去の症例報告を参考とする限りでは虫垂粘液嚢腫に対する腹腔鏡手術の妥当性は高く、腹腔鏡でも多くの病態に対応できることを考慮すると、本疾患に対しては腹腔鏡で手術を開始することが今後標準となりうる可能性が示唆された。
Appendiceal mucinous neoplasm(AMN) is relatively rare disease and it is very difficult to determine whether it is benign or malignant preoperatively. Therefore it’s important to do operation as minimal invasive as possible. Here we report that we could avoid over-invasive surgery using laparoscopic surgery. Case1 : 74 y.o. female. Asymptomatic mucocele was detected by abdominal ultrasonograpy as an annual screening. Preoperative CEA was high. Laparoscope assisted ileocecal resection (D2) was performed considering malignancy. Pathologically it was low-grade appendiceal mucinous neoplasm, and CEA immunohistochemistry was strongly positive. Case2 : 39 y.o. male. He had right lower abdominal pain. Computed tomography (CT) revealed mucocele of appendix, ascites was not observed. We aimed to do laparoscope assisted ileocecal resection, but laparoscope revealed that there was severe cancerous dissemination, so only staging laparoscopy was done. Considering case reports in the past, it can be reasonable to start the surgery for appendiceal mucinous neoplasm with laparoscope as standard procedure.
Publisher: 福島医学会
language: jpn
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/1013
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/1013/1/FksmMedJ_65_p192.pdf
ISSN: 0016-2582
Rights: © 2015 福島医学会
Appears in Collections:No.4 (2015-12)

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