INTESTINE Vol.23 No.1(6-2)


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 虫垂杯細胞カルチノイド (2) 診断と治療
発刊年月 2019年 02月
著者 清水 誠治 JR西日本大阪鉄道病院消化器内科
著者 小木曽 聖 JR西日本大阪鉄道病院消化器内科
著者 富岡 秀夫 JR西日本大阪鉄道病院消化器内科
著者 池田 京平 JR西日本大阪鉄道病院消化器内科
著者 上島 浩一 JR西日本大阪鉄道病院消化器内科
著者 横溝 千尋 JR西日本大阪鉄道病院消化器内科
著者 高島 英隆 JR西日本大阪鉄道病院消化器内科
【 要旨 】 杯細胞カルチノイドは虫垂に好発するまれな腫瘍であり，リンパ節転移や腹膜播種をきたすことが多く，癌の特殊型と考えられている．腫瘍はおもに粘膜下層以深を浸潤性に発育し，粘膜面に露出することはまれである．急性腹症で発症し，虫垂炎の術前診断で手術されることが多い，虫垂腫瘍，腸閉塞がこれに続く．術前診断は難しく，ほとんどが手術後に診断されている．CTでは虫垂腫大や造影効果を伴う回盲部の腸壁肥厚の所見がみられることが多い．大腸内視鏡や注腸X線が行われることは少なく，虫垂開口部の腫瘤や壁不整，盲腸の伸展不良や変形などの所見が記載されているが，内視鏡所見で異常がみられないこともある．また，生検組織診断は困難である．治療は外科的切除が基本であるが，進行した症例には大腸癌に準じた化学療法が行われる．
Theme Endocrine cell tumors of the colorectum: Difference in concept between WHO classification and Japanese classification
Title Diagnosis and treatment of goblet cell carcinoids of the appendix
Author Seiji Shimizu Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Kiyoshi Ogiso Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Hideo Tomioka Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Kyohei Ikeda Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Hirokazu Uejima Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Chihiro Yokomizo Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
Author Hidetaka Takashima Division of Gastroenterology and Hepatology, Osaka General Hospital of JR West Railway Company
[ Summary ] Goblet cell carcinoids are rare tumors mostly originating from the appendix. Since lymph node metastasis and/or peritoneal dissemination often accompany, it is considered to be a variant of carcinoma. Tumor cells have a tendency to spread in the submucosa and deeper layers without exposure to the mucosal surface. The major reason for operations is acute abdomen, followed by appendiceal tumors and intestinal obstruction. Diagnosis is rarely established before surgery, and is usually made by postoperative histology. As CT findings, swelling of the appendix and thickening of ileoceacal wall with contrast enhancement are described. Colonoscopy and/or barium enema X-rays are infrequently used. Findings may include masses or irregularities in the appendiceal orifice and strictures or deformities in the cecum. However, endoscopic findings may be normal. Histological diagnosis of biopsy specimens is often unsuccessful. Principally surgical resection is performed. However, chemotherapy for colorectal cancer is used in advanced cases.
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