直腸内に発育し扁平上皮癌を合併した尖圭コンジローマの1例

Condyloma Acuminatum with an Intrarectal Growth and the Coexistence of Squamous Cell Carcinoma, Report of a Case

要旨　症例は49歳，男性．体重減少を主訴に当科受診．同性愛者で肛門性行為の経験があった．下部消化管内視鏡検査で直腸下部に3/4周に広がる大小の隆起の集簇した奇妙な隆起性病変を認めた．隆起表面は顆粒状で柔らかく，白色調で一部発赤を伴っていた．生検で尖圭コンジローマと診断され，経肛門的切除を施行した．切除標本の病理診断では尖圭コンジローマに広範に異型上皮(anal intraepithelial neoplasia ; AIN)が併存し，その深層に扁平上皮癌の小病巣の合併が認められた．また，病変部組織からhuman papilloma virus6型のみが検出された．尖圭コンジローマの悪性化を示すまれな1例として，また直腸肛門管の腫瘍性疾患として形態学的にも興味深い1例と思われ報告する．

　A 49-years-old male visited our hospital with the complaint of body weight loss. He was homosexual and had had an experience of anal intercourse. Colonoscopy revealed an elevated lesion, which was an aggregation of nodules of various size, spreading throughout three quarters of the circumference of the lower rectum. The lesion was soft, whitish and slightly reddish in part, and had a granular surface. Histological findings of the biopsy specimen showed condyloma acuminatum, and trasanal surgery was performed. Microscopic findings of the resected specimen showed the wide-spread coexistence of dysplasia with condyloma acuminatum, and a small nest of squamous cell carcinoma in the basal layer. In addition, human papilloma virus (HPV), type 6, was detected by PCR analysis of the biopsy specimen.