INTESTINE Vol.23 No.1(3-2)


特集名 大腸内分泌細胞腫瘍─WHOの考え方と日本の考え方
題名 大腸内分泌細胞癌 (2) 診断と治療
発刊年月 2019年 02月
著者 松田 圭二 帝京大学外科
著者 八木 貴博 帝京大学外科
著者 福島 慶久 帝京大学外科
著者 島田 竜 帝京大学外科
著者 小澤 毅士 帝京大学外科
著者 端山 軍 帝京大学外科
著者 土屋 剛史 帝京大学外科
著者 野澤 慶次郎 帝京大学外科
著者 橋口 陽二郎 帝京大学外科
【 要旨 】 大腸内分泌細胞癌は,HE染色標本で低分化腺癌あるいは未分化癌と診断された症例に対して内分泌細胞への分化を確認し,カルチノイド腫瘍と鑑別することで確定する.診断時にすでに69~94%の症例に転移がみられ,Stage Ⅳの頻度も33~65%と高い.一方で内分泌細胞癌の術前診断率は6~24%と低い.治療はリンパ節郭清を伴った切除が原則である.しかし術後早期に再発し,急速に発育進展することも少なくない.化学療法は,近年では通常の大腸癌に用いられる薬剤(ベバシズマブ,オキサリプラチン,イリノテカン)が使われているが,奏効率は低く,確立された化学療法レジメンはない.予後はきわめて不良であり,生存期間中央値は10~11.4カ月である.
Theme Endocrine cell tumors of the colorectum: Difference in concept between WHO classification and Japanese classification
Title Diagnosis and treatment of colorectal endocrine cell carcinoma
Author Keiji Matsuda Department of Surgery, Teikyo University School of Medicine
Author Takahiro Yagi Department of Surgery, Teikyo University School of Medicine
Author Yoshihisa Fukushima Department of Surgery, Teikyo University School of Medicine
Author Ryu Shimada Department of Surgery, Teikyo University School of Medicine
Author Tsuyoshi Ozawa Department of Surgery, Teikyo University School of Medicine
Author Tamuro Hayama Department of Surgery, Teikyo University School of Medicine
Author Takeshi Tsuchiya Department of Surgery, Teikyo University School of Medicine
Author Keijiro Nozawa Department of Surgery, Teikyo University School of Medicine
Author Yojiro Hashiguchi Department of Surgery, Teikyo University School of Medicine
[ Summary ] Endocrine cell carcinoma of the colon is diagnosed by confi rming differentiation into endocrine cells for cases diagnosed as poorly differentiated adenocarcinoma or undifferentiated carcinoma in HE stained specimens, distinguishing it from carcinoid tumors. At the time of diagnosis, metastasis has already occurred in 69-94 % of cases, and the frequency of Stage Ⅳ is as high as 33-65 %. On the other hand, the preoperative diagnosis rate for endocrine cell carcinoma is as low as 6-24 %. Treatment is basically resection with lymph node dissection. However, this condition recurs early postoperatively and often develops rapidly. In recent years chemotherapy has been used including drugs commonly employed for colorectal cancer (bevacizumab, oxaliplatin, irinotecan). However, response rates are low and there is no established chemotherapy regimen. The prognosis for these patients is very poor, and median survival times are 10 to 11.4 months.
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