回腸末端部に発生したカルチノイド腫瘍の1例

Carcinoid Tumor in the Terminal Ileum, Report of a Case

要旨　患者は76歳，男性．近医で回腸末端の腫瘍を指摘され，生検でカルチノイドを疑われたため当科に紹介入院となった．注腸X線検査および大腸内視鏡検査で回腸末端に表面に陥凹を持つ約4cm大の粘膜下腫瘍を認めた．体外式超音波，¹²³I-MIBGシンチグラフィー，腹部CT所見もカルチノイドに矛盾せず，回腸カルチノイドの術前診断のもとリンパ節郭清を含む回盲部切除を行った．回盲弁より2cm口側の回腸に3.5×2.8×2.5cm大の亜有茎性粘膜下腫瘍を認め，病理組織学的には小型円形な核と両染性胞体を持った腫瘍細胞が充実性胞巣～管状構造を示し増殖していた．特殊染色，免疫染色と合わせ，カルチノイドと診断した．

　The patient was a 76-year-old man, admitted to our hospital for further examination of a tumor in the terminal ileum, the biopsy specimen of which was suspected to be carcinoid tumor. Colonoscopic examination and barium enema revealed a submucosal tumor with nodular surface and delle. Ultrasonography,¹²³I-MIBG scintigram and enhanced abdominal CT scan did not contradict the diagnosis of carcinoid tumor. The resected specimen showed a hemispheric solid tumor with nodular surface and delle, 35×28×25 mm in size, at the terminal ileum, and with lymph node metastasis. Relying on pathological and immunohistochemical examination, the final diagnosis was a carcinoid tumor.