盲腸の大型有茎性良悪性境界病変の1例

Large Villous Tumor of the Cecum, Report of a Case

要旨　患者は69歳，男性．盲腸に長径45mmの大型で卵形の有茎性のvillous tumorと考えられる腫瘍を認めた症例である．術後の組織学的診断では，villopapillary adenomaと診断され，細胞の偽重層が強いが，多形性，極性の乱れが少ないことから良悪性境界病変と考えられた．術前検査として，注腸X線検査と2回の内視鏡検査が行われたが，その検査所見にはかなりの差が認められた．3種類の検査にはそれぞれ異なった前処置が行われたが，この検査所見の差は，前処置の違いによることが想定された．回盲部の腫瘍は厚い粘液に覆われ，粘膜の洗浄が不十分な場合には，腫瘍の表面性状が正しく表現できないことがあると考えた．

　A patient reported here was a 69-year-old man who had a large villous tumor (measuring 45 mm) in the cecum.

　Villous tumor of the colon, in general, develops diffusely in the rectum or in the sigmoid colon, is short in height with no stalk. This patient, however, had large and oval villous tumor with an unequivocal stalk in the cecum.

　He underwent barium enema and colonoscopic examination twice as work up. These three occasions of examination resulted in discrepant diagnoses. We concluded that inadequate washing at the first colonoscopic examination led to the failure to reveal the lesion because of the mucus covering it.