特殊な進展形式を呈した下行結腸癌と悪性リンパ腫衝突腫瘍の1例
症例は85歳，女性．2019年10月，左顎下のリンパ節腫大を主訴とし，精査目的で当院形成外科に紹介受診．切除生検による病理診断の結果，悪性リンパ腫の診断となった．また，入院時に貧血を指摘され，精査の結果，同時性下行結腸癌の疑いの診断となり，後者の手術目的で総合外科へ紹介．11月，腹腔鏡下左半結腸切除術+D3リンパ節郭清術を施行した．切除標本の病理診断の結果，病変は中分化型管状腺癌（深達度T3）と漿膜下層の悪性リンパ腫の衝突腫瘍を形成しており，非常に稀なことに悪性リンパ腫の一部は腺癌を取り囲むような伸展形式を呈していた．郭清した所属リンパ節には腺癌の転移は認められなかったが，悪性リンパ腫細胞の増...
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| Published in | 日本臨床外科学会雑誌 Vol. 82; no. 3; pp. 595 - 603 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.82.595 |
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| Abstract | 症例は85歳，女性．2019年10月，左顎下のリンパ節腫大を主訴とし，精査目的で当院形成外科に紹介受診．切除生検による病理診断の結果，悪性リンパ腫の診断となった．また，入院時に貧血を指摘され，精査の結果，同時性下行結腸癌の疑いの診断となり，後者の手術目的で総合外科へ紹介．11月，腹腔鏡下左半結腸切除術+D3リンパ節郭清術を施行した．切除標本の病理診断の結果，病変は中分化型管状腺癌（深達度T3）と漿膜下層の悪性リンパ腫の衝突腫瘍を形成しており，非常に稀なことに悪性リンパ腫の一部は腺癌を取り囲むような伸展形式を呈していた．郭清した所属リンパ節には腺癌の転移は認められなかったが，悪性リンパ腫細胞の増生を伴っていた．術後，悪性リンパ腫に対して全身化学療法を施行し，完全寛解となったが，5月に中枢病変が出現．緩和的放射線治療を施行し，2020年8月の時点で中枢神経症状も安定している． |
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| AbstractList | 症例は85歳，女性．2019年10月，左顎下のリンパ節腫大を主訴とし，精査目的で当院形成外科に紹介受診．切除生検による病理診断の結果，悪性リンパ腫の診断となった．また，入院時に貧血を指摘され，精査の結果，同時性下行結腸癌の疑いの診断となり，後者の手術目的で総合外科へ紹介．11月，腹腔鏡下左半結腸切除術+D3リンパ節郭清術を施行した．切除標本の病理診断の結果，病変は中分化型管状腺癌（深達度T3）と漿膜下層の悪性リンパ腫の衝突腫瘍を形成しており，非常に稀なことに悪性リンパ腫の一部は腺癌を取り囲むような伸展形式を呈していた．郭清した所属リンパ節には腺癌の転移は認められなかったが，悪性リンパ腫細胞の増生を伴っていた．術後，悪性リンパ腫に対して全身化学療法を施行し，完全寛解となったが，5月に中枢病変が出現．緩和的放射線治療を施行し，2020年8月の時点で中枢神経症状も安定している． |
| Author | 豊福, 篤志 日暮, 愛一郎 笹栗, 毅和 是枝, 侑希 永田, 直幹 伊波, 悠吾 吉田, 昂平 |
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| References | 7) 岩崎謙一，三浦昭順，加藤 剛他:扁平上皮癌と神経内分泌細胞癌の成分を示した食道内衝突癌の1例．日臨外会誌 2012;73:2258-2264 24) Kus T, Aktas G, Kalender ME, et al : Collision tumor consisting of primary follicular lymphoma and adenocarcinoma in the cecum : A case report and literature review. Oncol Lett 2016 ; 11 : 2801-2805 29) Bordin GM, Key CR, McQuade CE, et al : Multiple primary cancers. Cancer 1977 ; 40 : 1793-1800 15) Chazouillères O, Andreani T, Poupon R, et al : Rectal adenocarcinoma in association with lymphoma (“collision tumor”). Gastroenterol Clin Biol 1990 ; 14 : 185-186 2) Cornes JS : Multiple primary cancers : primary malignant lymphomas and carcinomas of the intestinal tract in the same patient. J Clin Pathol 1960 ; 13 : 483-489 28) Schttenfeld D : Concluding commentary for the international workshop on multiple primary cancer. Cancer 1977 ; 40(4 Suppl) : 1982-1985 20) Devi P, Pattanayak L, Samantaray S : Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon. Saudi J Gastroenterol 2011 ; 17 : 69-71 31) Couzin-Franken J : Cancer Immunotherapy. Science 2013 ; 342 : 1432-1433 13) 森谷宜皓，小山靖夫，湊 啓輔他:進行盲腸癌病変中に微少悪性リンパ腫を認めた重複癌の1例．癌の臨 1985;31:894-899 10) Sasaki S, Hatanaka K, Ishimaru M, et al : Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon : report of a case. Surg Today 2010 ; 40 : 975-981 3) Billroth T : General Surgery, Pathology and Therapeutics. Additions by Winewater, Traslated by Hackley CE, Appleton Century Crofts, New York, 1889, p765 4) Warren S, Gates O : Multiple primary malignant tumors. A survey of the literature and a statistical study. Am J Cancer 1932 ; 16 : 1358-1414 22) Velu AR, Srinivasamurthy BC, Nagarajan K, et al : Colonic adenocarcinoma, mucosa associated lymphoid tissue lymphoma and tuberculosis in a segment of colon : A case report. World J Gastrointest Oncol 2014 ; 6 : 377-380 6) Spagnolo DV, Heenan PJ : Collision carcinoma at the esophagogastric junction : report of two cases. Cancer 1980 ; 46 : 2702-2708 27) Planker M, Fischer JT, Peters U, et al : Synchronous double primary malignant lymphoma of low grade malignancy and early cancer (collision tumor) of the stomach. Hepatogastroenterology 1984 ; 31 : 144-148 12) Kalisman M, DeBeer R, Pfeffer H : Adenocarcinoma arising from a lymphoma-case report. Clin Oncol 1979 ; 5 : 85-89 17) Padmanabhan V, Trainer TD : Synchronous adenocarcinoma and mantlecelllymphoma of the colon : a case report and review of the literature. Arch Pathol Lab Med 2003 ; 127 : e64-e66 11) Shigeno T, Fujimori K, Maejima T, et al : Ileocecal collision tumor composed of adenocarcinoma and primary malignant lymphoma. Clin J Gastroenterol 2011 ; 4 : 79-84 21) Lin HH, Jiang JK, Lin JK : Collision tumor of low-grade B-cell lymphoma and adenocarcinoma with tuberculosis in the colon : a case report and literature review. World J Surg Oncol 2014 ; 12 : 147 18) Eshra A, Al-Hendal A, Al-Enezi M, et al : One patient, two lymphomas, three primaries. Gulf J Oncolog 2010 ; 8 : 39-43 16) Mannweiler S, Dinges HP, Regauer S, et al : Colliding/concomitant tumors of the intestine : report of 3 cases. Pathol Oncol Res 2003 ; 9 : 188-192 9) 所 忠男，奥野清隆，肥田仁一他:直腸の悪性リンパ腫と腺癌の衝突腫瘍の1例．日臨外会誌 2010;71:1236-1240 26) Matsuda T, Ajiki W, Marugame T, et al : Population-based survival of cancer patients diagnosed between 1993 and 1999 in Japan : a chronological and international comparative study. Jpn J Clin Oncol 2011 ; 41 : 40-51 5) Meyer R : Bertrag zur Verstandigunf uber die Namengebung in der Geschwulstlehre. Zentralbl Allg Pathol 1919 ; 30 : 291-296 30) Le DT, Uram JN, Diaz LA Jr, et al : PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med 2015 ; 372 : 2509-2520 14) 相谷雅一，柏木雄次郎，渡辺雅俊他:横行結腸原発性悪性リンパ腫と腺癌のCOLLISION TUMORの1例．大阪警察病医誌 1987;11:97-103 23) Yu JR, Huang Q, Hou P, et al : Collision tumor of colonic adenocarcinoma and EBV-driven large B-cell lymphoma : A case report and review of literature. Cancer Treat Commun 2015 ; 3 : 7-12 19) Chang H, Chuang WY, Tang TC, et al : Collision in the colon : concurrent adenocarcinoma and diffuse large B-cell lymphoma in the same tumour. Acta Clin Belg 2011 ; 66 : 302-304 25) 福田弘武，森澤利之，山崎友裕他:内視鏡的粘膜下層剥離術にて診断された早期胃癌と悪性リンパ腫との衝突腫瘍の1例．日消誌 2018;115:923-929 1) Jinnai D, Iwasa Z, Watanuki T : Malignant lymphoma of the large intestine : operative results in Japan. Jpn J Surg 1983 ; 13 : 331-336 8) 湊 栄治，藤野一平，杉平宣仁他:上行結腸原発悪性リンパ腫と低分化腺癌の衝突腫瘍の1例．日消外会誌 2004;37:213-216 |
| References_xml | – reference: 4) Warren S, Gates O : Multiple primary malignant tumors. A survey of the literature and a statistical study. Am J Cancer 1932 ; 16 : 1358-1414 – reference: 28) Schttenfeld D : Concluding commentary for the international workshop on multiple primary cancer. Cancer 1977 ; 40(4 Suppl) : 1982-1985 – reference: 23) Yu JR, Huang Q, Hou P, et al : Collision tumor of colonic adenocarcinoma and EBV-driven large B-cell lymphoma : A case report and review of literature. Cancer Treat Commun 2015 ; 3 : 7-12 – reference: 8) 湊 栄治，藤野一平，杉平宣仁他:上行結腸原発悪性リンパ腫と低分化腺癌の衝突腫瘍の1例．日消外会誌 2004;37:213-216 – reference: 10) Sasaki S, Hatanaka K, Ishimaru M, et al : Collision tumor of primary malignant lymphoma and adenocarcinoma in the colon : report of a case. Surg Today 2010 ; 40 : 975-981 – reference: 17) Padmanabhan V, Trainer TD : Synchronous adenocarcinoma and mantlecelllymphoma of the colon : a case report and review of the literature. Arch Pathol Lab Med 2003 ; 127 : e64-e66 – reference: 1) Jinnai D, Iwasa Z, Watanuki T : Malignant lymphoma of the large intestine : operative results in Japan. Jpn J Surg 1983 ; 13 : 331-336 – reference: 19) Chang H, Chuang WY, Tang TC, et al : Collision in the colon : concurrent adenocarcinoma and diffuse large B-cell lymphoma in the same tumour. Acta Clin Belg 2011 ; 66 : 302-304 – reference: 6) Spagnolo DV, Heenan PJ : Collision carcinoma at the esophagogastric junction : report of two cases. Cancer 1980 ; 46 : 2702-2708 – reference: 12) Kalisman M, DeBeer R, Pfeffer H : Adenocarcinoma arising from a lymphoma-case report. Clin Oncol 1979 ; 5 : 85-89 – reference: 3) Billroth T : General Surgery, Pathology and Therapeutics. Additions by Winewater, Traslated by Hackley CE, Appleton Century Crofts, New York, 1889, p765 – reference: 5) Meyer R : Bertrag zur Verstandigunf uber die Namengebung in der Geschwulstlehre. Zentralbl Allg Pathol 1919 ; 30 : 291-296 – reference: 24) Kus T, Aktas G, Kalender ME, et al : Collision tumor consisting of primary follicular lymphoma and adenocarcinoma in the cecum : A case report and literature review. Oncol Lett 2016 ; 11 : 2801-2805 – reference: 18) Eshra A, Al-Hendal A, Al-Enezi M, et al : One patient, two lymphomas, three primaries. Gulf J Oncolog 2010 ; 8 : 39-43 – reference: 2) Cornes JS : Multiple primary cancers : primary malignant lymphomas and carcinomas of the intestinal tract in the same patient. J Clin Pathol 1960 ; 13 : 483-489 – reference: 7) 岩崎謙一，三浦昭順，加藤 剛他:扁平上皮癌と神経内分泌細胞癌の成分を示した食道内衝突癌の1例．日臨外会誌 2012;73:2258-2264 – reference: 27) Planker M, Fischer JT, Peters U, et al : Synchronous double primary malignant lymphoma of low grade malignancy and early cancer (collision tumor) of the stomach. Hepatogastroenterology 1984 ; 31 : 144-148 – reference: 30) Le DT, Uram JN, Diaz LA Jr, et al : PD-1 Blockade in Tumors with Mismatch-Repair Deficiency. N Engl J Med 2015 ; 372 : 2509-2520 – reference: 22) Velu AR, Srinivasamurthy BC, Nagarajan K, et al : Colonic adenocarcinoma, mucosa associated lymphoid tissue lymphoma and tuberculosis in a segment of colon : A case report. World J Gastrointest Oncol 2014 ; 6 : 377-380 – reference: 21) Lin HH, Jiang JK, Lin JK : Collision tumor of low-grade B-cell lymphoma and adenocarcinoma with tuberculosis in the colon : a case report and literature review. World J Surg Oncol 2014 ; 12 : 147 – reference: 14) 相谷雅一，柏木雄次郎，渡辺雅俊他:横行結腸原発性悪性リンパ腫と腺癌のCOLLISION TUMORの1例．大阪警察病医誌 1987;11:97-103 – reference: 11) Shigeno T, Fujimori K, Maejima T, et al : Ileocecal collision tumor composed of adenocarcinoma and primary malignant lymphoma. Clin J Gastroenterol 2011 ; 4 : 79-84 – reference: 20) Devi P, Pattanayak L, Samantaray S : Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon. Saudi J Gastroenterol 2011 ; 17 : 69-71 – reference: 13) 森谷宜皓，小山靖夫，湊 啓輔他:進行盲腸癌病変中に微少悪性リンパ腫を認めた重複癌の1例．癌の臨 1985;31:894-899 – reference: 9) 所 忠男，奥野清隆，肥田仁一他:直腸の悪性リンパ腫と腺癌の衝突腫瘍の1例．日臨外会誌 2010;71:1236-1240 – reference: 26) Matsuda T, Ajiki W, Marugame T, et al : Population-based survival of cancer patients diagnosed between 1993 and 1999 in Japan : a chronological and international comparative study. Jpn J Clin Oncol 2011 ; 41 : 40-51 – reference: 16) Mannweiler S, Dinges HP, Regauer S, et al : Colliding/concomitant tumors of the intestine : report of 3 cases. Pathol Oncol Res 2003 ; 9 : 188-192 – reference: 29) Bordin GM, Key CR, McQuade CE, et al : Multiple primary cancers. Cancer 1977 ; 40 : 1793-1800 – reference: 25) 福田弘武，森澤利之，山崎友裕他:内視鏡的粘膜下層剥離術にて診断された早期胃癌と悪性リンパ腫との衝突腫瘍の1例．日消誌 2018;115:923-929 – reference: 31) Couzin-Franken J : Cancer Immunotherapy. Science 2013 ; 342 : 1432-1433 – reference: 15) Chazouillères O, Andreani T, Poupon R, et al : Rectal adenocarcinoma in association with lymphoma (“collision tumor”). Gastroenterol Clin Biol 1990 ; 14 : 185-186 |
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| Title | 特殊な進展形式を呈した下行結腸癌と悪性リンパ腫衝突腫瘍の1例 |
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