直腸中部に6×4cmの結節集籏様adenoma with severe dysplasiaを認めた1例

Nodule-aggregating Adenoma of the Rectum with Severe Dysplasia (6×4 cm in Size), Report of a Case

要旨　患者は68歳，女性．血便を主訴として入院した．注腸造影検査で直腸に径5cmの顆粒集簇状粘膜を認め，壁の伸展性は良好であった．直腸内視鏡検査では，粘膜はびらん状で，生検では高度異型度を伴った腺管絨毛腺腫で，大きさの点から直腸切断術を施行した．切除標本では6×4cmの拡がりを示し，組織学的には，ほぼ全体が中等度の異型度を示す腺管絨毛腺腫であったが，病変の中央部に，高度異型度の部位をfocalに3か所認めた．

　A 68-year-old woman was examined at Yoshida Clinic. Her chief complain was bloody stool. Romanoscopy showed flat nodulated mucosa, 4 cm in size, in the rectum, and biopsy showed villous adenoma with moderate atypia.

　The patient was admitted to Hayashi Surgical Hospital. Barium enema examination showed nodule-aggregating mucosa, approximatelly 5 cm in size, in the rectum, but distensibility of the rectum was kept intact.

　Romanoscopy revealed erosive mucosa in the rectum, and biopsy specimen showed tubullo-villous adenoma with severe dysplasia. Surgical removal of the rectum was performed on September, 3rd, 1992.

　Macroscopically, the lesion was nodule-aggregating tumor, measuring 6 cm in length. Histological examination revealed mainly tubullo-villous adenoma with moderate dysplasia, and focally severe dysplasia in the central part of tumor.