A Case of Incidental Well-differentiated Papillary Peritoneal Mesothelioma at Laparoscopic Sigmoidectomy
نویسنده
چکیده
中皮腫は漿膜腔を覆う中皮細胞から発生する腫瘍で あり,多くは胸膜から生じ,腹膜原発は約10~20%と 報告されている .その中でも高分化型乳頭状中皮腫 (well-differentiated papillary mesothelioma:以下 WDPM)はまれな低悪性度の腹膜中皮腫の一種で女性 に好発する. 今回,われわれはS状結腸癌の診断で腹腔鏡下手術 を施行した際に,偶然WDPM を発見した1例を経験 したため報告する. 症 例 患者:71歳,男性. 主訴:血便. 既往歴:20歳代に虫垂切除術.石綿暴露歴なし. 現病歴:2カ月くらい前から血便が出現してきたた め近医を受診.血液検査にて貧血を指摘され精査・加 療目的に当院へ紹介となった. 初診時現症:腹部は平坦・軟で腫瘤は触知せず. 血液学的所見:Hb;11.7g/dlと軽度の貧血を認 め,CEA;7.1ng/mlと上昇していた.その他は特記す べき異常所見は認められず. 下部消化管内視鏡検査:S状結腸に1/2周性の2 型病変が認められ,生検にてGroup5(tub1-tub2)と の結果であった(Fig.1). 注腸造影検査:S状結腸の中央部に腫瘍による台形 状の側方変形を伴う陰影欠損像が認められた. 腹部造影 CT検査:S状結腸の一部に限局性の壁肥 厚を認めたが周囲への浸潤所見は認めず,転移を疑う リンパ節腫大も認められなかった.また肝転移や腹膜 播種を疑うような腫瘤・腹水も認められなかった(Fig. 2). 以上よりS状結腸癌(臨床病期:StageII)の診断 にて腹腔鏡下S状結腸切除術を施行する方針とした. 手術所見:腫瘍は術前診断通りS状結腸の中央部 に径5cm大程度の腫瘤として認められ,漿膜面の引 き連れがあり深 度はSSと考えられた.腹水は認め なかったもののS状結腸の腫瘍とは別に小腸間膜を 中心として腹腔内全体に数mm大の白色小結節が無 数に認められた(Fig.3a,b).S状結腸癌の腹膜播種 を疑い,腹腔洗浄細胞診と結節の数個を診断目的に採
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A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy
Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epithelioid mesothelioma, which is usually seen in young women without a history of asbestos exposure, and generally, has an indolent course. The relative rarity of this neoplasm in males prompted us to report this case of a well-differentiated papillary mesothelioma of the peritoneum in a 36-year-old man....
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