超音波内視鏡を施行した腸管子宮内膜症の2例―本邦超音波内視鏡所見報告例5例の検討を含めて

Endoscopic Ultrasonographic Findings of Intestinal Endometriosis, Report of Two Cases

要旨　腸管子宮内膜症の2例に超音波内視鏡検査を施行した．〔症例1〕は46歳，女性．月経時腹痛，血便を主訴に来院し，大腸内視鏡検査で遠位直腸に表面にびらんを形成する隆起性病変を認めた．〔症例2〕は41歳，女性．月経時血便を主訴に来院し，大腸内視鏡検査で遠位直腸に頂部が発赤した立ち上がりなだらかな隆起性病変を認めた．いずれも生検により腸管子宮内膜症と確診された．超音波内視鏡像は両症例とも第4層以深に主座を有する比較的均一な低エコー腫瘤として描出され，癌腫とは明らかに異なっていた．癌腫との鑑別診断において超削皮内視鏡は有用であったが粘膜下腫瘍，転移性癌との鑑別は現段階では困難である．本邦報告例中超音波内視鏡所見記載例の検討を加え報告する．

　We present two cases of intestinal endometriosis. The first case is a 46-year-old woman suffering from abdominal pain on menstruation and bloody stool. Colonoscopy revealed an elevated lesion with erosions in the upper rectum. The second case is a 41-year-old woman with a complaint of bloody stool on mentruation. Colonoscopy revealed a gentle elevation with a reddish summit in the middle rectum. Each case was diagnosed with intestinal endometriosis by the histological examination of the biopsy specimen. Endoscopic ultrasonography was performed in each case. We depicted a relatively homogenious hypoechoic mass located mainly in the forth layer or deeper of the rectal wall in each case, which was apparently different from primary cancer. Endoscopic ultrasonography is useful for the differentiation between intestinal endometriosis and primary cancer. However, the differentiation from the other submucosal tumors and metastatic cancer still remains to be difficult.