Kiyohisa Okamoto

Mixed medullary-papillary carcinoma of the thyroid with lymph node metastases: report of a case.

Abstract We report herein the case of a 77-year-old woman found to have mixed medullary-papillary carcinoma in the right thyroid with lymph node metastases 30 years after a left thyroidectomy. The preoperative values of serum calcitonin and carcinoembryonic antigen (CEA) were high, and fine-needle aspiration biopsy revealed class V, which led us to suspect papillary carcinoma. A right thyroidectomy with dissection of the right neck lymph nodes was performed. Histopathological examination of the tumor specimens revealed gradual borders between medullary carcinoma and papillary carcinoma with positive immunohistochemical staining to calcitonin, chromogranin A, CEA, and thyroglobulin. The serum levels of calcitonin and CEA decreased to normal after the operation. The point mutation of the RET proto-oncogene was found to be negative by a DNA analysis of the peripheral leukocytes. This cancer seemed not to be associated with multiple endocrine neoplasia type 2 syndrome. The presence of both medullary and papillary components in the thyroid with lymph node metastases is rare and may suggest that the tumor had arisen from a common stem cell.

A Case of Sigmoid Colon Cancer Associated with Periproctal Abscess

S状結腸癌穿通による肛門周囲膿瘍を経験した. 直腸癌による肛門周囲膿瘍はまれに報告されているが, S状結腸癌による症例は過去に報告がない. 症例は51歳の男性で, 肛門部痛を主訴に来院した. 骨盤部CT検査で坐骨直腸窩膿瘍と診断し, 切開排膿術を施行した. 術前より腫瘍マーカーの上昇を認めていたため, 局所の炎症が改善した時点で大腸ファイバー検査などにより精査した結果, S状結腸癌との診断を得た. 全身麻酔下に開腹したところ, ほぼ全周を占める2型腫瘍が存在し, 潰瘍底が骨盤底へ穿通し, さらに肛門挙筋群を穿破して坐骨直腸窩に膿瘍腔を形成していることが判明した. S状結腸切除術を施行し, 手術を終了した. 病理組織学的検査上, 高分化型腺癌であった. 腫瘍は, 固有筋層を越えていたが腹壁への癌細胞浸潤はなく, 根治的切除が可能であった. 肛門周囲膿瘍では, 本疾患を含めて悪性腫瘍が存在しうることも念頭におくべきであると考えられた.