虫垂入口部近傍に粘膜下腫瘍様の形態を示した大きさ18mmのIs＋IIc型sm癌の1例

Colonic sm Carcinoma 18 mm in Diameter Resembling Submucosal Tumor Near the Appendiceal Orifice, Report of a Case

要旨　患者は69歳，女性．2001年11月の大腸がん検診にて便潜血反応陽性を指摘され，当センターを受診．大腸内視鏡検査で，盲腸に大きさ18mmの粘膜下腫瘍様の隆起性病変を認めた．表面性状は，病変起始部から正常粘膜に覆われ，頂部には執拗に付着する白苔を伴った陥凹を有していた．その陥凹面に一致してVN型pit patternを認めたことから，粘膜下層深部に浸潤した大腸癌と診断し，腹腔鏡補助下回盲部切除術を施行．病理組織学的所見は，深達度sm₃の中～低分化腺癌で，癌巣周囲に著明なリンパ球浸潤を伴い，粘膜下腫瘍様の形態を呈した隆起型(いわゆるIs＋IIc型)大腸癌であった．

　A 69-year-old woman visited our center for further examination concerning positive fecal occult blood in November, 2001. Colonoscopy showed that there was a sessile lesion 18 mm in diameter resembling a submucosal tumor in the cecum. The surface of the lesion was the same as that of the surrounding mucosa and a central depression with firm whitish exsudate was on the top of the lesion. There were type VN pit patterns in the central depression. We diagnosed sm invasive cancer, so laparoscopic surgery was performed. Histological examination of the resected specimen showed moderately to poorly differentiated adenocarcinoma with marked lymphoid infiltration deeply invading the submucosa (sm₃), so we regarded the form of this tumor as sessile type (Is＋IIc type) colonic carcinoma resembling submucosal tumor.