びまん浸潤型を呈した直腸分化型腺癌の1例

Well-Differentiated Carcinoma of the Rectum with Diffuse Inflammatory Change, Report of a Case

要旨　患者は62歳，男性．便秘を主訴に受診．注腸造影検査では直腸S状結腸部に全周性の高度狭窄があり，内視鏡検査では狭窄部に敷石状変化を認めた．びまん浸潤型癌を疑い低位前方切除術を施行した．病理組織学的所見では，固有筋層の一部に浸潤しているが大部分は粘膜下層にとどまる高分化型腺癌を認めた．粘膜表層に腫瘍の一部が露出していたがほとんどは正常粘膜で覆われ，腫瘍の先進部や近傍にはCrohn病に類似した著明な炎症細胞浸潤や線維化，類上皮性細胞肉芽腫を認め，それによりびまん浸潤型の肉眼形態を呈していた．

　A 62-year-old male complaining of constipation was shown, by barium enema, to have a stenosis 4cm in length in the recto-sigmoid colon. Endoscopy showed nodular elevations like cobblestone in the narrowed portion. As malignancy could not be ruled out, low anterior resection was performed. Histological study showed a well differentiated adenocarcinoma spreading extensively in the submucosal layer with transmural inflammation. Most of the tumor was covered with normal mucosa. These inflammatory changes contained a lot of granulomas similar to those found in Crohn's disease.