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症例は56歳男性で貧血，肝機能障害，大腸ポリープを認め当院を受診した。41歳時に直腸癌にて直腸切断術の既往あり，大腸癌家族歴は認めず。今回多発する大腸癌，Vater乳頭部癌に対して手術を施行した。免疫染色にて癌病変部においてMSH2タンパクおよびMSH6タンパクの欠失を認めた。遺伝学的検査にてhMSH2遺伝子の生殖細胞系列変異が認められLynch 症候群と診断した。今回の症例について若干の文献的考察を加えて報告する。, A 56-years-old male presented at our hospital due to the symptoms of anemia, liver disfunction and colon polyps. He had resected rectal cancer at the ages of 41 and has no family history of colorectal cancer. A thorough examination for anemia resulted in detection of multiple colon cancer and cancer on ampulla of Vater. We performed total colectomy with dissection of regional lymph nodes and pancreaticoduodenectomy with dissection of regional lymph nodes. Immunohistochemical analysis showed a lack of MSH2 and MSH6 protein in the colon cancer and cancer on ampulla of Vater, and germline mutation of hMSH2 gene was recognized. Therefore, we diagnosed the case as Lynch syndrome.

帝王切開瘢痕部から発生する子宮体がんは極めて稀な疾患と考えられ、帝王切開瘢痕部の組織学的特性と子宮峡部癌の臨床的特徴および病理学的、遺伝学的特性を併せ持つ病態である。症例は54歳、3妊2産。2回の帝王切開術既往がある。子宮腺筋症に伴う月経困難症で前医に定期通院されていたが、子宮の病理学検査異常で当院紹介となった。子宮峡部前壁に発生する子宮体がんおよび子宮漿膜破綻を疑い、術前ⅢA期と診断し手術療法を行った。帝王切開瘢痕部の自然破綻を認め、子宮体がんⅢC1 期（類内膜癌、Grade2、pT3aN1M0）と診断した。術後再発高リスクのため補助化学療法を施行した。現在治療後1年経過し再発所見は認めていない。また、マイクロサテライト不安定性（MSI）検査は陽性であった。子宮峡部癌を含む帝王切開瘢痕部に発生する子宮体がんは様々な問題点が想起されるが、未だ病態解明が待たれる疾患であるため、今後の症例集積による知見の向上が期待される。, Endometrial cancer arising from caesarean section scars is an extremely rare disorder with the histological characteristics of caesarean section scars and the clinical, pathological, and genetic characteristics of endometrial cancer of the uterine isthmus. A 54-year-old woman with a history of three pregnancies (two caesarean sections) was being treated for dysmenorrhea associated with adenomyosis, and was referred to our hospital for abnormal pathological findings of the uterus. She was suspected of having endometrial cancer in the anterior wall of the uterine isthmus and rupture of the uterine serosa, preoperatively diagnosed as stage IIIA, and underwent surgery. She was diagnosed with stage IIIC1 endometrial cancer (endometrioid cancer, Grade 2, pT3aN1M0) with spontaneous rupture of caesarean section scar. Adjuvant chemotherapy was performed because of a high risk of postoperative recurrence. She has had an uneventful course after the surgery without recurrence for one year. The lesion was positive for microsatellite instability (MSI). Endometrial cancers, including that of the uterine isthmus, arising from caesarean section scars may cause various problems, although their pathology remains poorly defined. Further studies should be conducted in larger sample sizes.

A 40-year-old man had undergone right hemicolectomy and sigmoidectomy under the diagnosis of ascending andsigmoidcolon cancer andright nephroureterectomy under the diagnosis of right ureteral cancer, in 1997andin 2002, respectively. In 2007, He visitedour hospital with a complaint of bloody stool andhematuria. Colon fiberscopy, ureteropelvicscopy andcystoscopy demonstratedcolon cancer, left renal pelvis cancer and bladder cancer, respectively, as diagnosed by biopsies, followed by restative colectomy, left nephroureterectomy andcystectomy. The final histopathological examination showedwell differentiated adenocarcinoma (pSM) in the colon, and urothelial carcinoma in the left renal pelvis (pT2) and the bladder (pT1). Since his uncle andeld er brother hadsufferedfrom stomach cancer andcolon cancer, respectively, he was diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC : Lynch syndrome). He has been well doing without recurrence for 3 years after the surgery.