遠位腸閉塞と腸穿孔を呈した卵巣の悪性Brenner腫瘍

Malignant Brenner tumour of the ovary manifesting as distal intestinal obstruction and perforation.

• Brijesh Kumar Singh
• Sudipta Saha
• Shilpi Agarwal
• Yashwant Singh Rathore

抄録

本報告では、大腸浸潤による腸管穿孔を呈した卵巣の悪性ブレンナー腫瘍の稀な症例を詳述する。ブレンナー腫瘍は全卵巣新生物の1〜2％を占めており、悪性のブレンナー腫瘍はさらに稀であり、悪性のブレンナー腫瘍は約5％しかない。62歳の女性が1ヵ月間の腹痛、嘔吐、便秘の既往歴を持ち、右腸骨窩に触知可能な腫瘤を伴って救急外来を受診した。腹部X線写真は大腸閉塞を示唆していた．腹部造影CTで10.2×8.8cmの嚢胞性右卵巣腫瘤と気腹膜を認めた．探傷的開腹手術を行ったところ、右卵巣から発生した腫瘤が末期回腸、盲腸、上行結腸を巻き込んでいることが判明した。卵巣悪性腫瘍の可能性を残した。患者は、イレオストミーと下行結腸粘膜瘻が作成されたと一緒にデブルキング手術を受けた。組織学的には卵巣の悪性ブレンナー腫瘍と一致した。

A rare case of malignant Brenner tumour of ovary manifesting with intestinal perforation due to colonic infiltration is elaborated in the present report. Brenner's tumour accounts for 1%-2% of all ovarian neoplasms and malignant Brenner tumour is even rarer and only about 5% of Brenner tumours are malignant. A 62-year-old woman came to surgical emergency with 1-month history of abdominal pain, vomiting and constipation with a palpable mass in right iliac fossa. Abdominal radiograph was suggestive of colonic obstruction. Contrast-enhanced CT of the abdomen revealed cystic right ovarian mass of 10.2×8.8 cm with pneumoperitoneum. Exploratory laparotomy was done, which revealed mass arising from right ovary involving terminal ileum, cecum and ascending colon. Possibility of ovarian malignancy was kept. Patient underwent debulking surgery along with ileostomy and descending colon mucous fistula was created. Histology was compatible with malignant Brenner tumour of the ovary.

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