福島医学雑誌 60 巻 1 号 2010
〔症例報告〕
若年者発生の子宮体癌から発見された遺伝性非腺腫性大腸癌（HNPCC, hereditay non polyposis colorectal cancer）の1家系
森村 豊1)，橋本 歳洋1)，坂本 且一1)，羽生 忠義1),古川 茂宣2)西山 浩2)，山田 秀和2)，藤森 敬也2)
1)慈山会医学研究所付属坪井病院婦人科，2)福島県立医科大学医学部産科婦人科学講座
（受付2009年7月29日 受理2009年12月28日）
A Proband Accounted an Uterine Corpus Carcinoma in Young Woman Made to Detect One Family of Hereditary Non-polyposis Colorectal Carcinoma
YUTAKA MORIMURA1), TOSHIHIRO HASHIMOTO1), KATSUICHI SAKAMOTO1), TADAYOSHI HANYU1), SHIGENOBU HURUKAWA2), HIROSHI NISHIYAMA2), HIDEKAZU YAMADA2) and KEIYA FUJIMORI2)
1)Department of Gynecology, Jisannkai Medical Institute, Tsuboi Hospital, Kohriyama, 963-0197, Japan, 2)Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, 960-1295, Japan
要旨: 遺伝性非腺腫性大腸癌（Hereditary Non-Polyposis Colorectal Cancer, HNPCC）は大腸癌のみならず，子宮体癌，尿管癌，腎盂癌や小腸癌を好発する遺伝性疾患である。我々は，若年発症した子宮体癌例で，子宮摘出後8月目に大腸癌を発症し，家族歴の詳細な再聴取で明らかとなったHNPCCの1家系を経験した。
33歳の女性が持続性性器出血を主訴とし受診した。子宮内膜組織診で子宮体癌と診断された。ホルモン療法を6月試みたが，子宮内膜病変は消失せず，子宮摘出，骨盤リンパ節郭清が行われた。子宮体癌は子宮体部に限局し，筋層浸潤は1/2以内にとどまり，進行期はIb期であった。子宮摘出より8ヵ月後のfollow up CTで大腸腫瘍が認められ，大腸内視鏡でS状結腸癌が確認された。子宮摘出より10ヵ月後にS状結腸切除術が行われ，進行期IIIa（T1, N1, M0）と診断された。詳細な家族歴を再確認すると，患者の父は大腸癌と尿管癌，叔父が大腸癌，叔母が大腸癌と子宮体癌，祖母の姉が大腸癌に罹患していた。この家系はHNPCCの診断基準であるアムステルダム基準IIを満たしていた。若年の子宮体癌に遭遇した際は，詳細な家族歴を聴取することで，HNPCC家系を見逃さないことが重要である。
索引用語: 遺伝性非腺腫性大腸癌，子宮体癌，家族歴，アムステルダム基準II
Abstract: Hereditary non-polyposis colorectal cancer (HNPCC) is known as the frequent occurrence of not only colorectal cancer but also uterine corpus cancer, ureteral and renal pelvic cancer, and small intestinal cancer. We report a young woman who got uterine corpus carcinoma. She was a proband of a family of HNPCC, because she got colon cancer 8 months after hysterectomy for uterine corpus carcinoma.
A 33 year-old woman with continuously atypical genital bleeding admitted our hospital. Her endometrial biopsy revealed endometrial adenocarcinoma. After hormonal therapy during 6 months, her disease was persistent. Hysterectomy and pelvic lymphadenectomy was performed. Endometrial carcinoma localized in uterine corpus and invaded under half of myometrium. Her uterine corpus carcinoma was diagnosed as Stage Ib (T1b, N0, M0) disease. After 8 month of hysterectomy, pelvic computed tomography revealed colonic tumor. Subsquent biopsy at colon fiber showed adenocarcinoma of sigmoid colon. She received sigmoidectomy 10 month after hysterectomy. Her colonic disease was stage IIIa (T1, sm, N1, M0) disease.At this time her family history revealed her father with colon cancer and ureteral cancer, an uncle with colon cancer, an aunt with uterine corpus and colon cancer and a sister of her grandmother with colon cancer. Her disease and family history were satisfied for Amsterdam criteria II for define of HNPCC.
We should notify the detail family history at especially uterine corpus carcinoma in young women to not miss HNPCC.
Key words: Hereditary non-polyposis colorectal cancer, uterine corpus carcinoma, family history, Amsterdam criteria II