A case of ascending colon cancer with simultaneous brain and virchow’s　lymphnode metastases

症例は50歳代女性.意識障害を主訴に来院し,頭部CTにて脳腫瘍と診断.右下腹部に手拳大の腫瘤を触知し,腹部CTにて上行結腸腫瘍及び広範なリンパ節腫大を認めた.下部消化管内視鏡検査にて上行結腸に2型の腫瘍を認め,病理組織学的に管状腺癌と診断した.さらに,左鎖骨上に2cm大の硬性腫瘤を触知し,Virchowリンパ節転移と診断した.意識障害改善目的に脳転移に対しラジオサージャリー施行し,術後意識清明となった.原発巣に対しては出血および閉塞予防目的に回盲部切除術を施行した.術後全身状態改善し,mFOLFOX6療法1クール施行したが,誤嚥性肺炎を合併し術後42日目(入院62日目)に永眠した.同時性脳転移･Virchowリンパ節転移の頻度はそれぞれ0.1%と稀であり,さらに肝･肺転移を伴わない脳転移を契機に発見された上行結腸癌の症例を経験したため,文献的考察を加え報告する.

A 58-year-old female presented with chief complaint of disturbance of consciousness. Plain computed tomography scan showed an extensive low density area in the left temporal lobe and right frontal lobe. Further investigation showed far advanced ascending colon cancer with paraaortic and supraclavicular lymph node swellings by CT scan. Colonoscopy revealed a type 2 tumor in the ascending colon that was poorly differentiated adenocarcinoma histopathologically. Under diagnosis of advanced ascending colon cancer with brain metastasis and Virchow's lymph nodes without liver and lung metastases, we performed stereotactic radiosurgery for brain metastases, and the nervous symptoms disappeared. Ileocecal resection was perfomed for prevention of bleeding and intestinal occlusion. Chemothrapy with mFOLFOX6 were perfomed on 26 postoperative day, but she died 62 days after admission (42 postoperative day) by the cause of aspiration pneumonitis. Simultaneous brain and Virchow's metastases from colon cancer is extremely rare, and few patients survive more than one year postoperatively even with modality therapy, but performance status improved in neurologic status byradiosuregery.

同時性脳転移

Virchowリンパ節転移

放射線治療