術前化学療法によって腫瘍縮小化が図られ，有効な治療を完遂し得た 子宮頸部類内膜腺癌の 1 例

Abstract

子宮頸癌や腟癌の組織型は扁平上皮癌が多く，腺癌は比較的少ない．また，腺癌は扁平上皮癌に比して化学療法や放射線療 法の感受性が低いことから，進行期がⅠ期・Ⅱ期では手術療法が放射線療法よりも予後が良好であるとの報告がある．今回 我々は，腫瘍の主座が腟円蓋部にあり手術摘出が困難と考えられた腺癌に対し，術前化学療法（neoadjuvant chemotherapy： NAC）を施行することによって腫瘍の縮小化が図られ，その後手術摘出を完遂し得た症例を経験した． 症例は 48 歳，子宮腟部から腟腔内に突出する約 6㎝の低分化腺癌を認めた．子宮頸癌もしくは腟癌を疑い，NAC 施行後に 広汎子宮全摘術を施行した．摘出標本の病理検査結果は子宮頸部類内膜癌で，腟，直腸表面への浸潤を認めた．多臓器に浸潤 する子宮頸癌や腟癌にはしばしば同時化学放射線療法 (concurrent chemoradiotherapy：CCRT) が行われるが，腺癌の場合， より根治性の高いとされる手術療法を行うための選択肢の一つとして NAC が有効である可能性が示唆された．

Most of the malignant tumors located at the uterine cervix and vagina are squamous cell carcinoma. The treatment of each tumor is surgery or concurrent chemoradiotherapy (CCRT) decided by the tumor size and cancer stage. Adenocarcinoma of the uterine cervix and vagina is rare and less sensitive to radiation therapy and chemotherapy compared to squamous cell carcinoma. This report presents a case of large adenocarcinoma located at the uterine cervix and vagina that had invaded the serosa of the rectum, and was treated with neoadjuvant chemotherapy (NAC) and surgery. A 48-year-old multiparous woman presented with metrorrhagia Pelvic magnetic resonance imaging (MRI) revealed a 59mm× 62mm tumor located at the posterior wall of the vagina, uterine cervix and surface of the rectum. After NAC a complete resection was performed, and a pathological examination revealed to be an endometrioid carcinoma of the uterine cervix. Large and highly invaded vaginal and cervical tumors are often treated with CCRT. NAC, however, is a therapeutic option when the tumor is adenocarcinoma.