血清CEA・CA19-9の上昇を伴った腸間膜粘液性嚢胞腺腫の1例
症例は39歳，女性．下腹部痛で受診し，腹部造影CTにて右側腹部に7cm大の単胞性嚢胞性病変を認め，嚢胞壁の造影効果を伴い，腸管膜に発生した嚢胞性腫瘍と診断した．血液検査ではCEA・CA19-9の上昇を認めた．腸管との連続性が否定できず，腹腔鏡下回盲部切除術を施行した．腫瘍と子宮・両側付属器との接点はなく，病理検査で嚢胞壁と腸管との連絡も認めなかった．嚢胞壁内側が中等度の核異型を伴う背の低い単層性の円柱上皮からなっていた．免疫組織学的にはCK7陽性，CK20陽性，CDX2陰性であり，回盲部腸管膜原発の粘液性嚢胞腺腫と診断した．また，CEA・CA19-9陽性であった．術後経過は良好で症状も消失し，...
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| Published in | 日本臨床外科学会雑誌 Vol. 83; no. 5; pp. 891 - 897 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.83.891 |
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| Abstract | 症例は39歳，女性．下腹部痛で受診し，腹部造影CTにて右側腹部に7cm大の単胞性嚢胞性病変を認め，嚢胞壁の造影効果を伴い，腸管膜に発生した嚢胞性腫瘍と診断した．血液検査ではCEA・CA19-9の上昇を認めた．腸管との連続性が否定できず，腹腔鏡下回盲部切除術を施行した．腫瘍と子宮・両側付属器との接点はなく，病理検査で嚢胞壁と腸管との連絡も認めなかった．嚢胞壁内側が中等度の核異型を伴う背の低い単層性の円柱上皮からなっていた．免疫組織学的にはCK7陽性，CK20陽性，CDX2陰性であり，回盲部腸管膜原発の粘液性嚢胞腺腫と診断した．また，CEA・CA19-9陽性であった．術後経過は良好で症状も消失し，腫瘍マーカーも低下した．術後半年で再発も認めていない．腸管膜原発の粘液性嚢胞腺腫は稀であり報告する． |
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| AbstractList | 症例は39歳，女性．下腹部痛で受診し，腹部造影CTにて右側腹部に7cm大の単胞性嚢胞性病変を認め，嚢胞壁の造影効果を伴い，腸管膜に発生した嚢胞性腫瘍と診断した．血液検査ではCEA・CA19-9の上昇を認めた．腸管との連続性が否定できず，腹腔鏡下回盲部切除術を施行した．腫瘍と子宮・両側付属器との接点はなく，病理検査で嚢胞壁と腸管との連絡も認めなかった．嚢胞壁内側が中等度の核異型を伴う背の低い単層性の円柱上皮からなっていた．免疫組織学的にはCK7陽性，CK20陽性，CDX2陰性であり，回盲部腸管膜原発の粘液性嚢胞腺腫と診断した．また，CEA・CA19-9陽性であった．術後経過は良好で症状も消失し，腫瘍マーカーも低下した．術後半年で再発も認めていない．腸管膜原発の粘液性嚢胞腺腫は稀であり報告する． |
| Author | 小竹, 優範 尾山, 佳永子 羽田, 匡宏 原, 拓央 加藤, 洋介 三田, 和芳 |
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| References | 5) Linden PA, Ashley SW : Mucinous cystadenocarcinoma of the mesentery. Surgery 2000 ; 127 : 707-708 21) 緒方健一，菊池暢之，土居浩一他:8年以上経過し，胸壁，胸腰椎，肝臓に転移した，上行結腸間膜より発生した粘液性囊胞腺腫の1例．日臨外会誌 2006;67:1138-1142 7) Talwar A, Bell NJ, Nicholas D : Mucinous cystadenoma of the colonic mesentery : report of a case. Dis Colon Rectum 2004 ; 47 : 1412-1414 19) Del Gobbo A, Bimbatti M, Ferrero S, et al : A case report of mesenteric mucinous cystadenoma with review of the literature. BMC Gastroenterol 2010 ; 10 : 105 23) 齋藤 学，亀高 尚，牧野裕庸他:小腸間膜原発の粘液性囊胞腺癌の1例．日臨外会誌 2018;79:2437-2442 15) Felemban A, Tulandi T : Laparoscopic excision of a mesenteric cyst diagnosed preoperatively as an ovarian cysts. J Am Assoc Gynecol Laparosc 2000 ; 7 : 429-431 11) Bury TF, Pricolo VE : Malignant transformation of benign mesenteric cyst. Am J Gastroenterol 1994 ; 89 : 2085-2087 27) 塚本徹哉，稲田健一，黒田 誠:病理診断医になじみのある疾患関連分子CDX2（caudal type homeobox 2） 解説編・診断編．病理と臨 2011;29:161-168 32) Kelly PJ, Archbold P, Price JH, et al : Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol 2010 ; 63 : 169-173 30) Albarracin CT, Jafri J, Montag AG, et al : Differential expression of MUC2 and MUC5AC mucin genes in primary ovarian and metastatic colonic carcinoma. Hum Pathol 2000 ; 31 : 672-677 4) McEvoy AW, Cahill CJ, Jameson C : Mucinous cystadenoma of the sigmoid mesocolon : a previously unreported abdominal tumour. Eur J Surg Oncol 1997 ; 23 : 88-90 28) Min W, Haifen M, Yunbao P, et al : PAX2 and PAX8 reliably distinguishes ovarian serous tumors from mucinous tumors. Appl Immunohistochem Mol Morphol 2015 ; 23 : 280-287 8) Zwaveling S, den Outer AJ, de Costa SA : A mucinous cystadenoma in the mesentery of the right hemicolon. Acta Chir Belg 2008 ; 108 : 354-355 25) Lee MJ, Lee HS, Klim WH, et al : Expression of mucins and cytokeratins in primary carcinomas of the digestive system. Mod Pathol 2003 ; 16 : 403-410 10) Cohen I, Altaras M, Lew S, et al : Huge mesenteric mucinous cystadenoma in nourmal pregnancy. Obset Gynecol 1988 ; 71 : 1030-1032 13) Shiono S, Suda K, Nobukawa B, et al : Pancrearic, hepatic, splenic, and mesenteric mucinous cyst neoplasms(MCN) are lumped together as extra ovarian MCN. Pathol Int 2006 ; 56 : 71-77 17) Cauchy F, Lefevre JH, Mourra N, et al : Mucinous cystadenoma of the mesocolon, a rare entity frequentrly presenting with features of malignancy : two case reports and review of the literature. Clin Res Hepatol Gastoenterol 2012 ; 36 : 12-16 29) 鈴木 裕，杉山政則，阿部展次他:膵および卵巣粘液性嚢胞腫瘍の免疫組織学的類似性に関する検討．膵臓 2008;23:182-184 22) 小林 完，大石 晋，吉原秀一他:卵巣腫瘍との鑑別を要した虫垂間膜原発粘液性囊胞腺腫の1例．日臨外会誌 2011;72:3166-3170 2) Alwan MH, Eid AS, Alsharif IM, et al : Retroperitoneal and mesenteric cysts. Singapore Med J 1999 ; 40 : 160-164 14) Luo JJ, Baksh FK, Pfeifer JD, et al : Abdominal mucinous cystic neoplasm in a male child. Pediatr Dev Pathol 2008 ; 11 : 46-49 26) Vang R, Gown AM, Barry TS, et al : Cytokeratins 7 and 20 in primary and secondary mucinous tumors of ovary : analysis of coordinate immunohistochemical expression profiles and staining distribution in 179 cases. Am J Surg Pathol 2006 ; 30 : 1130-1139 18) Tan A, Li R, Rafique M, et al : A rare case of giant extra-ovarian mucinous cystadenoma arising from sigmoid mesocolon. J Surg Case Rep 2018 ; 2018 : rjy038. doi : 10.1093/jsrc/rjy038 20) 木村憲央，村田暁彦，小山 基他:腸管膜から発生した粘液性囊胞腺腫の1例．日臨外会誌 2005;66:2296-2300 6) Vrettos ME, Kostopoulou E, Papavasileiou C, et al : A mucinous tumor of the mesocolon with features of borderline malignancy. Surg Endosc 2000 ; 14 : 595 16) Thamboo TP, Sim R, Tan SY, et al : Primary retroperitoneal mucinous cystadenocarcinoma in a male patient. J Clin Pathol 2006 ; 59 : 655-657 3) Banerjee R, Gough J : Cystic mucinous tumours of the mesentery and retroperitoneum : report of three cases. Histopathology 1988 ; 12 : 527-532 9) Metaxas G, Tangalos A, Pappa P, et al : Mucinous cystic neoplasms of the mesentery : acase report and review of the literature. World J Surg Oncol 2009 ; 7 : 47 1) Kurtz RJ, Heimann TM, Holt J, et al : Mesenteric and retroperitoneal cysts. Ann Surg 1986 ; 203 : 109-112 31) 豊田暢彦，竹内 勤，皆木真一他:囊胞液中のCEAおよびCA19-9が異常高値を示した粘液性膵囊胞腺腫の1例．日臨外会誌 1994;55:1270-1274 24) Chu P, Wu E, Weiss LM : Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms : a survey of 435 cases. Mod Pathol 2000 ; 13 : 962-972 12) Czubalski A, Barwijuk A, Radiuliewicz G : Large mesenteric cyst in patient suspected of ovarian cyst. Ginekol Pol 2004 ; 75 : 545-547 |
| References_xml | – reference: 30) Albarracin CT, Jafri J, Montag AG, et al : Differential expression of MUC2 and MUC5AC mucin genes in primary ovarian and metastatic colonic carcinoma. Hum Pathol 2000 ; 31 : 672-677 – reference: 32) Kelly PJ, Archbold P, Price JH, et al : Serum CA19.9 levels are commonly elevated in primary ovarian mucinous tumours but cannot be used to predict the histological subtype. J Clin Pathol 2010 ; 63 : 169-173 – reference: 22) 小林 完，大石 晋，吉原秀一他:卵巣腫瘍との鑑別を要した虫垂間膜原発粘液性囊胞腺腫の1例．日臨外会誌 2011;72:3166-3170 – reference: 9) Metaxas G, Tangalos A, Pappa P, et al : Mucinous cystic neoplasms of the mesentery : acase report and review of the literature. World J Surg Oncol 2009 ; 7 : 47 – reference: 31) 豊田暢彦，竹内 勤，皆木真一他:囊胞液中のCEAおよびCA19-9が異常高値を示した粘液性膵囊胞腺腫の1例．日臨外会誌 1994;55:1270-1274 – reference: 4) McEvoy AW, Cahill CJ, Jameson C : Mucinous cystadenoma of the sigmoid mesocolon : a previously unreported abdominal tumour. Eur J Surg Oncol 1997 ; 23 : 88-90 – reference: 24) Chu P, Wu E, Weiss LM : Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms : a survey of 435 cases. Mod Pathol 2000 ; 13 : 962-972 – reference: 12) Czubalski A, Barwijuk A, Radiuliewicz G : Large mesenteric cyst in patient suspected of ovarian cyst. Ginekol Pol 2004 ; 75 : 545-547 – reference: 6) Vrettos ME, Kostopoulou E, Papavasileiou C, et al : A mucinous tumor of the mesocolon with features of borderline malignancy. Surg Endosc 2000 ; 14 : 595 – reference: 1) Kurtz RJ, Heimann TM, Holt J, et al : Mesenteric and retroperitoneal cysts. Ann Surg 1986 ; 203 : 109-112 – reference: 15) Felemban A, Tulandi T : Laparoscopic excision of a mesenteric cyst diagnosed preoperatively as an ovarian cysts. J Am Assoc Gynecol Laparosc 2000 ; 7 : 429-431 – reference: 20) 木村憲央，村田暁彦，小山 基他:腸管膜から発生した粘液性囊胞腺腫の1例．日臨外会誌 2005;66:2296-2300 – reference: 11) Bury TF, Pricolo VE : Malignant transformation of benign mesenteric cyst. Am J Gastroenterol 1994 ; 89 : 2085-2087 – reference: 14) Luo JJ, Baksh FK, Pfeifer JD, et al : Abdominal mucinous cystic neoplasm in a male child. Pediatr Dev Pathol 2008 ; 11 : 46-49 – reference: 13) Shiono S, Suda K, Nobukawa B, et al : Pancrearic, hepatic, splenic, and mesenteric mucinous cyst neoplasms(MCN) are lumped together as extra ovarian MCN. Pathol Int 2006 ; 56 : 71-77 – reference: 21) 緒方健一，菊池暢之，土居浩一他:8年以上経過し，胸壁，胸腰椎，肝臓に転移した，上行結腸間膜より発生した粘液性囊胞腺腫の1例．日臨外会誌 2006;67:1138-1142 – reference: 18) Tan A, Li R, Rafique M, et al : A rare case of giant extra-ovarian mucinous cystadenoma arising from sigmoid mesocolon. J Surg Case Rep 2018 ; 2018 : rjy038. doi : 10.1093/jsrc/rjy038 – reference: 5) Linden PA, Ashley SW : Mucinous cystadenocarcinoma of the mesentery. Surgery 2000 ; 127 : 707-708 – reference: 7) Talwar A, Bell NJ, Nicholas D : Mucinous cystadenoma of the colonic mesentery : report of a case. Dis Colon Rectum 2004 ; 47 : 1412-1414 – reference: 26) Vang R, Gown AM, Barry TS, et al : Cytokeratins 7 and 20 in primary and secondary mucinous tumors of ovary : analysis of coordinate immunohistochemical expression profiles and staining distribution in 179 cases. Am J Surg Pathol 2006 ; 30 : 1130-1139 – reference: 27) 塚本徹哉，稲田健一，黒田 誠:病理診断医になじみのある疾患関連分子CDX2（caudal type homeobox 2） 解説編・診断編．病理と臨 2011;29:161-168 – reference: 19) Del Gobbo A, Bimbatti M, Ferrero S, et al : A case report of mesenteric mucinous cystadenoma with review of the literature. BMC Gastroenterol 2010 ; 10 : 105 – reference: 28) Min W, Haifen M, Yunbao P, et al : PAX2 and PAX8 reliably distinguishes ovarian serous tumors from mucinous tumors. Appl Immunohistochem Mol Morphol 2015 ; 23 : 280-287 – reference: 2) Alwan MH, Eid AS, Alsharif IM, et al : Retroperitoneal and mesenteric cysts. Singapore Med J 1999 ; 40 : 160-164 – reference: 8) Zwaveling S, den Outer AJ, de Costa SA : A mucinous cystadenoma in the mesentery of the right hemicolon. Acta Chir Belg 2008 ; 108 : 354-355 – reference: 16) Thamboo TP, Sim R, Tan SY, et al : Primary retroperitoneal mucinous cystadenocarcinoma in a male patient. J Clin Pathol 2006 ; 59 : 655-657 – reference: 23) 齋藤 学，亀高 尚，牧野裕庸他:小腸間膜原発の粘液性囊胞腺癌の1例．日臨外会誌 2018;79:2437-2442 – reference: 29) 鈴木 裕，杉山政則，阿部展次他:膵および卵巣粘液性嚢胞腫瘍の免疫組織学的類似性に関する検討．膵臓 2008;23:182-184 – reference: 25) Lee MJ, Lee HS, Klim WH, et al : Expression of mucins and cytokeratins in primary carcinomas of the digestive system. Mod Pathol 2003 ; 16 : 403-410 – reference: 3) Banerjee R, Gough J : Cystic mucinous tumours of the mesentery and retroperitoneum : report of three cases. Histopathology 1988 ; 12 : 527-532 – reference: 10) Cohen I, Altaras M, Lew S, et al : Huge mesenteric mucinous cystadenoma in nourmal pregnancy. Obset Gynecol 1988 ; 71 : 1030-1032 – reference: 17) Cauchy F, Lefevre JH, Mourra N, et al : Mucinous cystadenoma of the mesocolon, a rare entity frequentrly presenting with features of malignancy : two case reports and review of the literature. Clin Res Hepatol Gastoenterol 2012 ; 36 : 12-16 |
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| Title | 血清CEA・CA19-9の上昇を伴った腸間膜粘液性嚢胞腺腫の1例 |
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