回腸末端まで側方発育した巨大大腸結節集簇様病変（表層拡大型腫瘍）の1例

Superficially Widespread Nodule-aggregating Lesion in the Ascending Colon, Cecum and Terminal Ileum, Report of a Case

要旨　症例は85歳，女性．嘔吐・便秘の精査目的のため，大腸内視鏡検査を施行したところ，上行結腸より回腸末端まで側方発育した結節集簇様病変（表層拡大型腫瘍）を認めた．肉眼形態は結節状＋絨毛状型を示し，結節は比較的均一でpit patternはIII_L型～IV型であった．腺腫内癌を強く疑い，腹腔鏡補助下右半結腸切除術を施行した．切除標本では腫瘍は上行結腸・盲腸・回腸末端に及ぶ大きさ11×11cmの結節集簇様病変で，病理組織学的には，ほとんどが高分化腺癌で腺管絨毛腺腫も混在しており，TypeIIa＋I，carcinoma with tubulovillous adenoma，m，ly₀，v₀，n₀と診断した．回腸末端まで進展した結節集簇様病変（表層拡大型腫瘍）の本邦における文献的報告はなく，臨床病理学的考察を加えて報告する．

　An 85-year-old woman was admitted to our hospital with the chief complaints of nausea and vomiting. Endoscopic findings showed a superficially widespread Nodule-aggregating lesion in the ascending colon, cecum and terminal ileum. Laparoscopic right hemicolorectomy was performed. The resected specimen showed a superficially widespread Nodule-aggregating lesion measuring 11×11 cm in size, in the ascending colon, cecum and terminal ileum. Histological examination showed a well differentiated adenocarcinoma with invasion limited to the mucosal layer with tubulovillous adenoma. No lymph node metastasis was seen. There are very few cases of a nodule-aggregating lesion extending so widely, 11×11 cm in size, with invasion as far as the terminal ileum.