拡大観察にて術前に腸結核に合併した上行結腸癌と診断可能であった1例―自験例および本邦報告70例の検討

Carcinoma in the Ascending Colon Diagnosed by Magnifying Colonoscopy and Associated with Colonic Tuberculosis, Report of a Case

要旨　患者は78歳，女性．血便にて近医を受診した．注腸検査にて異常を指摘され，精査目的に当院紹介となる．注腸X線精査で横行～上行結腸にかけて腸管の短縮，変形および回盲弁の破壊も認めることから腸結核と診断したが，本病変中肝彎曲部に壁変形を伴う陥凹性病変を認めた．大腸内視鏡検査では，①陥凹性病変を構成する潰瘍辺縁が不整であること，②拡大観察にて，潰瘍辺縁にV型pitが観察されたことから大腸結核に合併した大腸癌と診断した．病変は38×27mm大，中分化腺癌，深達度ssであった．腫瘍部周辺部に，多数の類上皮肉芽腫を伴う粘膜下層の強い線維化と固有筋層の肥厚を認め，病理学的にも腸結核に合併した大腸癌と診断した．拡大内視鏡は腸結核症に合併した大腸癌の肉眼診断にも有用と考えられた．

　A 78-year-old woman visited a nearby hospital with the complaint of occult blood in her stool. Barium enema examination revealed marked shortening of the ascending colon, pseudo-diverticula formation of the ascending colon, deformity of the iliocecal valve, and a depressed tumor in the hepatic flexure. Colonoscopy revealed an ulcerative tumor, the margin of the depressed area of which was irregular, in the hepatic flexure. Magnifying colonoscopy revealed type V pit pattern in the depressed area. The biopsy specimen of this lesion disclosed adenocarcinoma.

　Histological examination of the resected specimen revealed moderately differentiated adenocarcinoma (measuring 38×27 mm) in the ascending colon, marked submucosal fibrosis and non-caseating granuloma with Langhans-type giant cells in the deep portion surrounding the tumor. These findings were characteristic of carcinoma associated with tuberculosis. We thus reported a first case of colonic carcinoma, associated with tuberculosis and diagnosed by magnifying colonoscopy before operation.