Yu Xiaolin, Nishimura Taku, Kijima Taiki, Setoguchi Mihoko
Dept. of Gastroenterological Surgery, JCHO Shimonoseki Medical Center.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1796-1798.
An 84-year-old woman presented with anorexia. CT showed ascending colon and multiple liver tumors, and a colonoscopy showed severe stenosis due to a tumor in the ascending colon. We diagnosed obstructive colon cancer with multiple liver metastases. It was difficult to approach this case with a colonic stent, and we suggested a colostomy, but the patient strongly objected and requested to undergo resection; thus, a laparoscopic right hemicolectomy was performed. Intraoperatively, there was no normal liver tissue, and liver metastases were diffuse. Histopathologically, neuroendocrine carcinoma and differentiated tubular adenocarcinoma were found; MANEC was diagnosed. Oral intake was started on the third postoperative day, but liver failure progressed gradually. Despite the best supportive care and medication, the patient died of liver failure 16 days after surgery. We report our experience of a MANEC case with a poor prognosis along with a literature review.
一名84岁女性因厌食症就诊。CT显示升结肠和多发肝肿瘤，结肠镜检查显示升结肠肿瘤导致严重狭窄。我们诊断为梗阻性结肠癌伴多发肝转移。采用结肠支架处理该病例较为困难，我们建议行结肠造口术，但患者强烈反对并要求进行切除手术；因此，实施了腹腔镜右半结肠切除术。术中发现无正常肝组织，肝转移呈弥漫性。组织病理学检查发现神经内分泌癌和分化型管状腺癌；诊断为混合性神经内分泌-非神经内分泌癌（MANEC）。术后第三天开始经口进食，但肝功能衰竭逐渐进展。尽管给予了最佳的支持治疗和药物治疗，患者仍在术后16天死于肝功能衰竭。我们报告了这例预后不良的MANEC病例的经验并进行文献复习。
