径4mmのS状結腸mp癌の1症例

Small Invasive Cancer Presenting NPG Type in the Sigmoid Colon, Report of a Case

要旨　患者は50歳，女性．家族歴として母親に大腸癌，母方の従兄弟に膵臓癌と胃癌各1名．1996年7月左乳癌の診断にて当院乳腺外科にて根治的手術(非定型的左乳房切除術)を施行した．T2NlbM0 Stage Ⅱ．病理組織型schirrhous carcinoma．入院時の便潜血検査が陽性であったため大腸内視鏡検査，注腸X線検査を施行したところS状結腸に径8mmのⅡa＋Ⅱc病変を認めた．生検ではwell differentiated adenocarcinomaが認められた．術前画像診断にて微小ながら，深部浸潤の所見を認め，術前予想深達度SM₃以深と診断し1996年11月7日根治的手術(S状結腸切除術，D₃郭清)を施行した．切除標本の病理組織学的診断にて径4mmのⅡa＋Ⅱc病変であり，深達度はmpであった．この症例は当施設最小のmp癌である．

　A 50-year-old woman was admitted for the operation of partial mammonectomy for right breast cancer. Because of occult blood found in her stool examination, detailed tests were performed.

　Colonoscopic examination and barium enema radiograph showed a small tumor in the sigmoid colon. The lesion was accompanied by a central depression at the top and scattered small depressions in the margin region. The result of biopsy was well-differentiated adenocarcinoma. With a diagnosis of sigmoid colon cancer invading the proper muscle layer in preoperative imaging, sigmoidectomy (D₃) was performed. Histopathologically, the lesion was diagnosed as partly well differentiated adenocarcinoma and partly moderately differentiated adenocarcinoma. The size of this tumor was 4 mm but the tumor extended vertically to the proper muscle layer. It presented the (NPG) non polypoid growth pattern. This case was thought to present the properties of small invasive colorectal cancer presenting NPG type.