粘膜ひだの多方向からの集中像が深達度診断に有用であった小型の大腸癌の1例

Small Colon Carcinoma with Prominent Fold Convergence which was Useful for the Diagnosis of Depth of Invasion, Report of a Case

要旨　患者は73歳男性．肛門管癌の既往で定期的に経過観察されていたが，貧血が進行するため精査が行われた．注腸検査や内視鏡検査にて横行結腸に径10mmのⅠs型隆起性病変を認めた．正面像にて粘膜ひだの多方向からの集中像を認めた，側面像は得られず，側面変形による深達度診断は不可能であった．手術が施行され，粘膜下深層まで浸潤した高分化腺癌であり，粘膜下層を中心に強い線維化を認めた．粘膜ひだの多方向からの集中像は粘膜下層への浸潤を示唆する所見で，腫瘍の浸潤に伴う反応性線維化がその原因と考えられた．

　We report a case of early colon cancer with prominent fold convergence. The patient, a 73-year old man, presented progressive anemia. Barium enema and endoscopy showed an elevated lesion, 10 mm in diameter, in the transverse colon with prominent fold convergence. Local resection of the colon was performed. Pathological examination revealed the lesion as a well differentiated adenocarcinoma with submucosal invasion. Dense fibrosis was demonstrated in the submucosa. The finding of fold convergence suggests submucasal invasion and desmoplastic reaction due to submucal invasion causes fold convergence.