Satoshi Kamiya

Seven-year survivor with malignant melanoma of the anus without radical surgery

We report a case of a long-term survivor with malignant melanoma of the anus who did not undergo radical surgery. A 71-year-old woman who presented with anal bleeding and anal tumor underwent an excisional biopsy in September 1985. The biopsy specimen was a lobulated, polypoid, pigmented mass 2 cm in diameter, that had been located on the anterior wall of the anus. A satellite nodule 7 mm in diameter was found on the left wall of the anus at the level of the dentate line. Both tumors were histologically diagnosed as malignant melanoma. The primary tumor was 6 mm thick. Melanoma cells were present microscopically at the cut end of the rectum. Because of her history of ischemic heart disease, the patient rejected our recommendation that she undergo radical surgery, and received 10 courses of carboplatin 20 mg intramuscularly and OK-432 10 K.E. (Klinische Einheit) intradermally every week. A single, pigmented metastatic inguinal lymph node developed and was excised in June 1987. A recurrent tumor was detected in the rectum in October 1992, so again we recommended radical surgery. The patient rejected radical surgery again, and received 12 courses of carboplatin 10 mg intramuscularly every 2 weeks. She died of disease at home in July 1993 after surviving for 7 years and 10 months. An autopsy was not performed. This case shows that local excision of the primary lesion may be appropriate to preserve the quality of life of patients with early-stage malignant melanoma of the anus.

A Case of Cholangiocellular Carcinoma with Tumor Growth in the Hepatic Hilar Bile Duct.

患者は72歳の男性. 閉塞性黄疸を指摘され紹介となった. CTで肝左葉と肝門部胆管内に低吸収域の腫瘤を認めた. 胆管造影で肝門部胆管内に卵円形の陰影欠損像を認めた. 腹部血管造影で中肝動脈より栄養される腫瘍濃染像を認めた. 以上より肝門部胆管内に腫瘍発育をした胆管細胞癌と診断し, 拡大左葉切除, 尾状葉切除, 胆管切除を施行した. 切除標本の検索で腫瘤の主体は肝実質内の5×4cm大の腫瘤で左肝管から肝門部胆管内に腫瘍発育していた. 病理組織学的検査では胆管細胞癌と診断された. 患者は術後13か月無再発生存中である.胆管細胞癌の進展形式において充実癌が肝門部胆管内への腫瘍発育することはまれであるが, 術式選択上重要であると思われたため報告する.

A Case of Omental Actinomycosis due to Perforation by Fishbone.

魚骨穿孔に続発した大網放線菌症の1例を経験したので本邦報告例を検討し報告する. 症例は62歳の女性. 主訴は腹部腫瘤. 理学的所見にて右下腹部に可動性不良で弾性硬の約15cm大の腫瘤を触知した. 大腸X線造影検査では横行結腸壁の鋸歯状変化を認めた. 腹部CTでは腫瘤は内部不均一で横行結腸壁との境界が不明瞭であった. 大網腫瘤の診断で手術を行ったところ, 大網の炎症性腫瘤が横行結腸と胃の一部を巻き込んでいた. 切除標本で腫瘤の内部に膿瘍がありその中に魚骨を認めた. 病理組織検査で放線菌症と診断された. 魚骨穿孔に続発した腹部放線菌症は本邦で6例報告されており, 腹部腫瘤を主訴にするものが多く, 穿孔部位は下部消化管に多く術前診断できたものは1例もなかった. 本症は診断が困難であるが, 腹腔内腫瘤の鑑別診断の1つとして念頭におく必要がある.