Togano Shingo, Shibutani Masatsune, Maeda Kiyoshi, Yashiro Masakazu, Nagahara Hisashi, Ohtani Hiroshi, Sakurai Katsunobu, Yamazoe Sadaaki, Kimura Kenjiro, Toyokawa Takahiro, Amano Ryosuke, Kubo Naoshi, Tanaka Hiroaki, Muguruma Kazuya, Ohira Masaichi, Hirakawa Kosei
Dept. of Surgical Oncology, Osaka City University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2014 Nov;41(12):1614-6.
A 64-year-old man underwent sigmoidectomy for sigmoid colon cancer 9 years ago. We attempted to discontinue surveillance, as the postoperative course was event free for 5 years; however, we continued the follow-up on the patient's request. Nine years after the operation, elevation of the serum carcinoembryonic antigen (CEA) level was detected, and positron emission tomography-computed tomography (PET-CT) showed a 35-mm mass with an abnormal signal (SUVmax 18.6 Bq/ mL). We performed an abdominal CT and magnetic resonance imaging and found the mass invading the sigmoid colon. We suspected lymph node recurrence of the sigmoid colon cancer and considered curative surgery to be appropriate as there were no other signs of recurrence. We therefore excised the tumor by sigmoidectomy. A histopathological examination revealed metastatic adenocarcinoma in the lymph node. One year after the second operation, there was no evidence of recurrence on imaging and the levels of tumor markers were within the normal limits. Few reports have documented recurrence over 5 years after surgery. We herein describe our case and report the characteristics of a recurrent lesion and also suggest a protocol for surveillance, taking into consideration the previous literature.
一名64岁男性9年前因乙状结肠癌接受了乙状结肠切除术。由于术后5年病情无进展，我们曾试图停止监测；然而，应患者要求我们继续进行随访。术后9年，检测到血清癌胚抗原（CEA）水平升高，正电子发射断层扫描-计算机断层扫描（PET-CT）显示一个35毫米的肿块，信号异常（最大标准化摄取值18.6 Bq/mL）。我们进行了腹部CT和磁共振成像检查，发现肿块侵犯乙状结肠。我们怀疑乙状结肠癌发生了淋巴结转移，由于没有其他复发迹象，认为根治性手术是合适的。因此，我们通过乙状结肠切除术切除了肿瘤。组织病理学检查显示淋巴结中有转移性腺癌。第二次手术后一年，影像学检查未发现复发迹象，肿瘤标志物水平在正常范围内。很少有报告记录术后5年以上复发的情况。我们在此描述我们的病例，报告复发病变的特征，并结合既往文献提出一个监测方案。
