病徵依然未變..
不看好, 朋友不知道能活多久......
今年標靶治療和電療, 健保有給付的樣子...
他老兄才30出頭..

項目...
急乙種診斷書（中文）CERTIFICATES FEE非2TMS 2 1.
乙狀結腸惡性腫瘤合併肝臟及肺臟轉移。
2. 腸阻塞。

患者於民國104年09月03日及09月10日至門診求治，於民國104年09月13日經門診住院，於民國104年09月14日接受乙狀結腸切除術及腸吻合手術治療，因病情穩定於民國104年09月19日出院，宜休養兩週及門診追蹤治療。

病理報告:
Sigmoid colon, sigmoidectomy, adenocarcinoma.
Lymph node status: Metastasis in regional lymph node(s)(4/6).
[pT4aN2aM1b]

SUMMARY OF GROSS AND MICROSCOPIC FINDINGS:
SPECIMEN: Sigmoid colon.
SPECIMEN LENGTH: 11 cm.
TUMOR SIZE: 6.5x2.5x0.9 cm.
MACROSCOPIC TUMOR PERFORATION: not identified.
HISTOLOGIC TYPE: adenocarcinoma.
HISTOLOGIC GRADE: well differentiated.
TYPE OF POLYP IN WHICH INVASIVE CARCINOMA AROSE: None identified.
HISTOLOGIC FEATURES SUGGESTIVE OF MICROSATELLITE INSTABILITY:
Intratumoral Lymphocytic Response: Mild to moderate.
Peritumor Lymphocytic Response: Marked.
Tumor Subtype and Differentiation: Nil.
TNM DESCRIPTORS:
PRIMARY TUMOR(pT): pT4a: Tumor penetrates the visceral peritoneum.
REGIONAL LYMPH NODES(pN): pN2a= Metastasis in 4 to 6 regional lymph nodes.
DISTANT METASTASIS(pM): pM1b: Metastasis to more than one organ/site or to the peritoneum.
MARGINS:
Proximal margin: uninvolved.
Distal margin: uninvolved.
Circumferential (radial) or mesenteric margin: involved by invasive carcinoma (tumor present 0-1 mm from margin).
TREATMENT EFFECT: No prior treatment.
LYMPHATIC INVASION: Present.
VASCULAR INVASION: Venous: Present.
PERINEURAL INVASION: Present.
PERITONEUM: involved by tumor.
ADDITIONAL PATHOLOGIC FINDINGS: None identified.

GROSS DESCRIPTION:
The specimen (1) received consists of a segment of sigmoid colon, 11 cm in length. The external surface of mesocolon and serosal surface are focally firm and retracted. On the mucosal surface, 2 cm away from one resection margin and 2 cm away from another resection margin, there is a grayish friable fungating and ulcerative tumor measuring 6.5x2.5x0.9 cm in size. On cut section, the tumor appears to invade into pericolic fat. The tumor is 4.5 cm away from the circumference (radial) surgical margins grossly. Multiple regional lymph nodes measuring up to 1.7 cm in greatest dimension are dissected out. Two separate rings of colon tissue, labelled as proximal and distal surgical margins are present.

The specimen (2) submitted consists of a piece of soft tissue measuring 1.5 cm in greatest dimension, labeled as peritoneal biopsy, with a tan white and firm lesion, 0.5 cm in greatest dimension.
All for section.

Representative sections are taken & labelled as follows:
a1-13: main tumor.
a14: non-neoplastic colon.
b1-5, x: regional lymph nodes and/or tumor deposit(s)
c1-2: surgical margin (c1: proximal, c2: distal) from separate rings.
d: cut end of mesocolon at high point of resection.
e: peritoneal biopsy.