嚢腫破裂により腫瘍マーカーが高値を示した脾類上皮嚢腫の1例
脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である. 今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した非常にまれな脾類上皮嚢腫の1症例を経験したので報告する. 症例は24歳の女性, 下腹部痛を主訴として当院受診し, 精査加療の目的で婦人科に入院した. 腹部超音波, CTおよびMRI検査にて下腹部に多量の腹水と脾臓内に不整形嚢胞を認め, 脾嚢胞破裂による腹膜炎と診断した. 血中CEA, CA19-9が高値のため消化管を中心に全身検索を行ったが, 他には異常所見がなく, その間に臨床症状も改善した. その後, 経過観察中に腫瘍マ...
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| Published in | 日本消化器外科学会雑誌 Vol. 33; no. 9; pp. 1696 - 1700 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
01.09.2000
一般社団法人日本消化器外科学会 The Japanese Society of Gastroenterological Surgery |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.33.1696 |
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| Abstract | 脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である. 今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した非常にまれな脾類上皮嚢腫の1症例を経験したので報告する. 症例は24歳の女性, 下腹部痛を主訴として当院受診し, 精査加療の目的で婦人科に入院した. 腹部超音波, CTおよびMRI検査にて下腹部に多量の腹水と脾臓内に不整形嚢胞を認め, 脾嚢胞破裂による腹膜炎と診断した. 血中CEA, CA19-9が高値のため消化管を中心に全身検索を行ったが, 他には異常所見がなく, その間に臨床症状も改善した. その後, 経過観察中に腫瘍マーカー値はすべて正常化したが, 脾嚢胞は増大し再破裂が危ぐされたため, 脾摘術を施行した. 手術所見では脾門部を中心に長径9.5cmの嚢胞を認め, 病理組織検査で扁平上皮からなる壁を有する類上皮性嚢腫と診断した. また, 嚢腫内液のCEA, CA19-9は高値であった. |
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| AbstractList | 脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である. 今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した非常にまれな脾類上皮嚢腫の1症例を経験したので報告する. 症例は24歳の女性, 下腹部痛を主訴として当院受診し, 精査加療の目的で婦人科に入院した. 腹部超音波, CTおよびMRI検査にて下腹部に多量の腹水と脾臓内に不整形嚢胞を認め, 脾嚢胞破裂による腹膜炎と診断した. 血中CEA, CA19-9が高値のため消化管を中心に全身検索を行ったが, 他には異常所見がなく, その間に臨床症状も改善した. その後, 経過観察中に腫瘍マーカー値はすべて正常化したが, 脾嚢胞は増大し再破裂が危ぐされたため, 脾摘術を施行した. 手術所見では脾門部を中心に長径9.5cmの嚢胞を認め, 病理組織検査で扁平上皮からなる壁を有する類上皮性嚢腫と診断した. また, 嚢腫内液のCEA, CA19-9は高値であった. 脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である.今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した非常にまれな脾類上皮嚢腫の1症例を経験したので報告する.症例は24歳の女性, 下腹部痛を主訴として当院受診し, 精査加療の目的で婦人科に入院した.腹部超音波, CTおよびMRI検査にて下腹部に多量の腹水と脾臓内に不整形嚢胞を認め, 脾嚢胞破裂による腹膜炎と診断された.血中CEA, CA19-9が高値のため消化管を中心に全身検索を行ったが, 他には異常所見がなく, その間に臨床症状も改善した.その後, 経過観察中に腫瘍マーカー値はすべて正常化したが, 脾嚢胞は増大し再破裂が危ぐされたため, 脾摘術を施行した.手術所見では脾門部を中心に長径9.5cmの嚢胞を認め, 病理組織検査で扁平上皮からなる壁を有する類上皮性嚢腫と診断した.また, 嚢腫内液のCEA, CA19-9は高値であった. Over five hundred cases of splenic cysts have been reported in Japan. Epidermoid cysts are comparatively rare, accounting for about 10% of all splenic cysts. This paper reports a very rare case of a ruptured epidermoid cyst of the spleen presenting as generalized peritonitis and associated with high levels of tumor antigens. A 24-year-old female was admitted to the Gynecological & Obstetrical Department of our hospital because of a lower abdonimal pain. Ultrasonography, magnetic resonance imaging and computed tomography revealed several ascites in the pelvic cavity and an irregular-shaped cyst in contact with the spleen. A diagnosis of peritonitis as a result of a ruptured splenic cyst was made. High levels of serum carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)were also detected, so additional examinations targeting the digestive tract were performed. However, no other abnormal findings were found. Although the abdominal pain disappeared and the serum tumor antigen levels decreased to within a normal range after conservative treatment, the primary splenic cyst increased in size. Since a secondary rupture was expected to occur, a splenectomy was performed. The cyst had a diameter of 9.5 cm and was localozed in the central segment of the spleen. Microscopically, the cyst conteined a stratified squamous epithelium on the inner surface and was diagnosed as an epidermoid cyst of the spleen. The contents of the cyst included high levels of CEA and CA 19-9. |
| Author | 金井, 俊雄 伊澤, 光 金, 成泰 西原, 政好 吉田, 哲也 藤本, 高義 戎井, 力 |
| Author_FL | IZAWA Hikaru EBISUI Tikara KANAI Toshio KIM Songtae NISHIHARA Masayoshi FUJIMOTO Takayoshi YOSHIDA Tetsuya |
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| References | 10) Terada T, Yasoshima M, Yoshimitsu Y et al: Carbohydrate antigen 19-9 producing giant epithelial cyst of the spleen in a young woman. J Clin Gastroenterol 18: 57-61, 1994 21) Machesky KK, Cushing RD: Overwhelming postsplenectomy infection in a patient with penicillin-resistant Streptococcus pneumoniae. Arch Fam Med 7: 178-180, 1998 16) Spence RAJ, Dane TEB: Spontaneous rupture of an epithelial cyst of the spleen. Postgrad Med J 59: 65, 1983 22) Thoma R, Postel J: Fulminant sepsis following posttraumatic splenectomy-OPSI (overwhelming postsplenectomy infection) syndrome. Anaesthesist 38: 379-382, 1989 29) Toth L, Takacs K, Balika Z et al: Splenectomy and spleen autotransplantation due to splenic cyst. Acta Chir Hung 36: 364-365, 1997 13) Ishibashi R, Sakai T, Yamashita Y et al: Benign epithelial cyst of the spleen with a high production of carbohydrate antigen 19-9. Int Surg 84: 151-154, 1999 18) Panossian DH, Wang N, Reeves CD et al: Epidermoid cyst of the spleen presenting as a generalized peritonitis. Am Surg 56: 295-298, 1990 27) Yavorski CC, Greason KL, Egan MC: Splenic cysts: a new approach to partial splenectomy--case report and review of the literature. Am Surg 64: 795-798, 1998 30) Elit L, Aylward B: Splenic cyst carcinoma presenting in pregnancy. Am J Hematol 32: 57-60, 1989 24) Stryker RM, Orton DW: Overwhelming postsplenectomy infection. Ann Emerg Med 17: 161-164, 1988 5) 櫻井薫, 唐司則之, 天野穂高ほか: 脾リンパ管腫の1例. 千葉医63: 225-229, 1987 12) Higaki K, Jimi A, Watanabe J et al: Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol 22: 704-708, 1998 20) King H, Shumacher HB: Splenic studies I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 136: 239-242, 1952 1) 小川吾一, 光吉貢, 内田隆寿ほか: 脾部分切除を行った脾嚢腫の1例. 日臨外医会誌52: 650-656, 1991 4) McClure RD, Altemeier WA: Cysts of the spleen. Ann Surg 116: 98-102, 1942 25) Moorman DW, Evans DM, Wright DJ: Segmental splenectomy using the ultrasonic surgical aspirator. Am J Surg 155: 266-267, 1988 6) 大内慎一郎, 瀬戸泰士, 花岡農夫ほか: 脾類上皮嚢胞の1例. 臨外50: 1361-1364, 1995 7) Fowler RH: Cystic tumors of the spleen. Int Absi Surg 96: 209-227, 1953 19) 佐々木信好, 角岡秀彦, 岸川輝彰ほか: 小児の類上皮嚢腫, 1治験例と本邦における脾嚢報告161例の統計学的観察. 日小児外会誌13: 627-636, 1977 23) Frezzato M, Castaman G, Rodeghiero F: Fulminaunt sepsis in adults splenectomized for Hodgkin's disease. Haematologica 78: 73-77, 1993 8) 加藤雅道, 大村豊, 大橋大造ほか: 脾に発生した類表皮嚢胞の1治験例. 日臨外医会誌50: 2261-2265, 1989 11) Yoshikane H, Suzuki T, Yoshioka N et al: Giant splenic cyst with high serum concentration of CA 19-9. Failure of treatment with percutaneous transcatheter drainage and injection of tetracycline. Scand J Gastroenterol 31: 524-526, 1996 26) Uranus S, Kronberger L, Kraft-Kine J: Partial splenic resection using the TA-stapler. Am J Surg 168: 49-53, 1994 3) Robbins FG, Yellin AE, Lingua RW et al: Splenic epidermoid cysts. Ann Surg 187: 231-235, 1978 28) Sellers GJ, Starker PM: Laparoscopic treatment of a benign splenic cyst. Surg Endosc 11: 766-678, 1997 15) 金秀男, 勝見正治, 田伏克惇ほか: 自然破裂を疑った脾類表皮嚢腫の1例. Arch Jpn Chir 50: 911-917, 1981 17) Rathaus V, Zissin R, Goldberg E: Spontaneous rupture of an epidermoid cyst of spleen: preoperative ultrasonographic diagnosis. J Clin Ultrasound 19: 235-237, 1991 9) Sardi A, Ojeda HF, King D Jr: Laparoscopic resection of a benign true cyst of the spleen with the harmonic scalpel producing high levels of CA 19-9 and carcinoembrvonic antigen. Am Surg 64: 1149-1154, 1998 2) 有田久松: 脾臓血嚢腫治験. 順天堂医事研報89: 905-911, 1890 14) 山口隆: 外傷性嚢腫内血腫と感染を伴った脾epidermoid cystの1例. 日臨外医会誌44: 1357-1365, 1983 |
| References_xml | – reference: 28) Sellers GJ, Starker PM: Laparoscopic treatment of a benign splenic cyst. Surg Endosc 11: 766-678, 1997 – reference: 13) Ishibashi R, Sakai T, Yamashita Y et al: Benign epithelial cyst of the spleen with a high production of carbohydrate antigen 19-9. Int Surg 84: 151-154, 1999 – reference: 17) Rathaus V, Zissin R, Goldberg E: Spontaneous rupture of an epidermoid cyst of spleen: preoperative ultrasonographic diagnosis. J Clin Ultrasound 19: 235-237, 1991 – reference: 20) King H, Shumacher HB: Splenic studies I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 136: 239-242, 1952 – reference: 26) Uranus S, Kronberger L, Kraft-Kine J: Partial splenic resection using the TA-stapler. Am J Surg 168: 49-53, 1994 – reference: 8) 加藤雅道, 大村豊, 大橋大造ほか: 脾に発生した類表皮嚢胞の1治験例. 日臨外医会誌50: 2261-2265, 1989 – reference: 2) 有田久松: 脾臓血嚢腫治験. 順天堂医事研報89: 905-911, 1890 – reference: 11) Yoshikane H, Suzuki T, Yoshioka N et al: Giant splenic cyst with high serum concentration of CA 19-9. Failure of treatment with percutaneous transcatheter drainage and injection of tetracycline. Scand J Gastroenterol 31: 524-526, 1996 – reference: 24) Stryker RM, Orton DW: Overwhelming postsplenectomy infection. Ann Emerg Med 17: 161-164, 1988 – reference: 12) Higaki K, Jimi A, Watanabe J et al: Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol 22: 704-708, 1998 – reference: 4) McClure RD, Altemeier WA: Cysts of the spleen. Ann Surg 116: 98-102, 1942 – reference: 7) Fowler RH: Cystic tumors of the spleen. Int Absi Surg 96: 209-227, 1953 – reference: 19) 佐々木信好, 角岡秀彦, 岸川輝彰ほか: 小児の類上皮嚢腫, 1治験例と本邦における脾嚢報告161例の統計学的観察. 日小児外会誌13: 627-636, 1977 – reference: 3) Robbins FG, Yellin AE, Lingua RW et al: Splenic epidermoid cysts. Ann Surg 187: 231-235, 1978 – reference: 16) Spence RAJ, Dane TEB: Spontaneous rupture of an epithelial cyst of the spleen. Postgrad Med J 59: 65, 1983 – reference: 15) 金秀男, 勝見正治, 田伏克惇ほか: 自然破裂を疑った脾類表皮嚢腫の1例. Arch Jpn Chir 50: 911-917, 1981 – reference: 23) Frezzato M, Castaman G, Rodeghiero F: Fulminaunt sepsis in adults splenectomized for Hodgkin's disease. Haematologica 78: 73-77, 1993 – reference: 18) Panossian DH, Wang N, Reeves CD et al: Epidermoid cyst of the spleen presenting as a generalized peritonitis. Am Surg 56: 295-298, 1990 – reference: 5) 櫻井薫, 唐司則之, 天野穂高ほか: 脾リンパ管腫の1例. 千葉医63: 225-229, 1987 – reference: 21) Machesky KK, Cushing RD: Overwhelming postsplenectomy infection in a patient with penicillin-resistant Streptococcus pneumoniae. Arch Fam Med 7: 178-180, 1998 – reference: 25) Moorman DW, Evans DM, Wright DJ: Segmental splenectomy using the ultrasonic surgical aspirator. Am J Surg 155: 266-267, 1988 – reference: 22) Thoma R, Postel J: Fulminant sepsis following posttraumatic splenectomy-OPSI (overwhelming postsplenectomy infection) syndrome. Anaesthesist 38: 379-382, 1989 – reference: 14) 山口隆: 外傷性嚢腫内血腫と感染を伴った脾epidermoid cystの1例. 日臨外医会誌44: 1357-1365, 1983 – reference: 27) Yavorski CC, Greason KL, Egan MC: Splenic cysts: a new approach to partial splenectomy--case report and review of the literature. Am Surg 64: 795-798, 1998 – reference: 1) 小川吾一, 光吉貢, 内田隆寿ほか: 脾部分切除を行った脾嚢腫の1例. 日臨外医会誌52: 650-656, 1991 – reference: 29) Toth L, Takacs K, Balika Z et al: Splenectomy and spleen autotransplantation due to splenic cyst. Acta Chir Hung 36: 364-365, 1997 – reference: 10) Terada T, Yasoshima M, Yoshimitsu Y et al: Carbohydrate antigen 19-9 producing giant epithelial cyst of the spleen in a young woman. J Clin Gastroenterol 18: 57-61, 1994 – reference: 6) 大内慎一郎, 瀬戸泰士, 花岡農夫ほか: 脾類上皮嚢胞の1例. 臨外50: 1361-1364, 1995 – reference: 30) Elit L, Aylward B: Splenic cyst carcinoma presenting in pregnancy. Am J Hematol 32: 57-60, 1989 – reference: 9) Sardi A, Ojeda HF, King D Jr: Laparoscopic resection of a benign true cyst of the spleen with the harmonic scalpel producing high levels of CA 19-9 and carcinoembrvonic antigen. Am Surg 64: 1149-1154, 1998 |
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| Snippet | 脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である. 今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した... 脾嚢腫は本邦で500例余りが報告されているが, 類上皮嚢腫はその約10%で比較的まれな疾患である.今回, 嚢腫破裂による急性腹症で発症し, 腫瘍マーカーが異常高値を呈した非... |
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| Title | 嚢腫破裂により腫瘍マーカーが高値を示した脾類上皮嚢腫の1例 |
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| ispartofPNX | 日本消化器外科学会雑誌, 2000, Vol.33(9), pp.1696-1700 |
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