腸結核に合併し特異な形態を呈した大腸癌の1例

Colonic Carcinoma with Unusual Appearance Complicating Colonic Tuberculosis, Report of a Case

要旨　症例は80歳代，女性．汎発性帯状疱疹の基礎疾患検索のため消化管精査が行われた．大腸X線・内視鏡検査にて，回盲弁の開大，回腸終末部から下行結腸まで腸管の短縮，偽憩室・萎縮瘢痕帯形成を認めたため腸結核が疑われた．さらに，横行結腸遠位および下行結腸近位部に腫瘍性病変を認め，横行結腸の一部には陰影欠損も伴っており大腸癌の合併と診断，結腸亜全摘術が施行された．病理学的には，下行結腸の絨毛状病変部は腺腫内癌で粘膜内にとどまっていたが，横行結腸の結節集簇様病変部では漿膜下層へ浸潤する高分化型腺癌であった．背景粘膜は腸結核に矛盾しない所見であった．

　A woman in her 80's was diagnosed as having generalized herpes zoster and she was examined to detect the cause of her immunocompromised state. She was suspected to have colonic tuberculosis after barium enema and colonoscopy revealed multiple ulcerations, scars, marked shortening of the proximal colon, and deformity of the ileo-cecal valve. Furthermore, 2 lesions of colonic carcinoma were found in the distal transverse and proximal descending colon, so subtotal colectomy was performed. Histological examination of the resected specimen showed 2 lesions of well-differentiated adenocarcinoma, proximally invading the subserosa. We report a rare case of colonic carcinoma complicating colonic tuberculosis.