鑑別診断に苦慮したS状結腸原発びまん浸潤型大腸癌の1例

Diffusely Infiltrating Type of Sigmoid Colon Carcinoma Whose Differential Diagnosis was Difficult, Report of a Case

要旨　患者は，46歳，女性．左卵巣腫瘍の診断で，当院婦人科で腹式子宮全摘術ならびに両側付属器摘出術を施行，その際，手術中に左側結腸に腫瘤を触知したため，術後，精査目的に当院消化器科を受診した．注腸X線で，S状結腸に全周性の伸展不良と腸管長軸方向に直交した多数の線状陰影を認めたが，粘膜面に明らかな陥凹は指摘できなかった．内視鏡は，その狭窄のため，poor studyであった．内腔からの盲目的生検では，Group1であった．性，年齢，画像所見からは，腸管子宮内膜症も考えられたが，癌を否定できず，S状結腸切除術を施行，結果，深達度ssのびまん浸潤型大腸癌であり，卵巣病変は，その転移と診断された．

　We encountered a 46-year-old woman who, while undergoing abdominal hysterectomy and bilateral salpingo-oophorectomy, was found to have abnormalities in the sigmoid colon. Roentgenologic examination of the large intestine revealed a relatively narrow segment of the sigmoid colon and shortening in its long axis. The ulcer lesion was not able to be detected clearly. Endoscopically, because of severe stenosis, it was not possible to observe the lumen. The specimen obtained by blind biopsy was insufficient to demonstrate malignancy. From sex, age, and the results of examinations, intestinal endometriosis was considered, but since the possibility of cancer still remained, a partial resection of the sigmoid colon was undertaken. Pathological examination revealed a diffusely infiltrating type of sigmoid colon carcinoma with marked lymphovascular invasion, fibrosis and muconodules, and metastatic ovarian tumor.