虫垂杯細胞カルチノイドの1例

Goblet Cell Carcinoid of the Appendix, Report of a Case

要旨　患者は51歳，男性．主訴は右下腹部痛と発熱．触診で右下腹部に圧痛のある手拳大の腫瘤を触知した．注腸X線検査では盲腸外側からの壁外性圧排を認めた．大腸内視鏡検査では，盲腸外側に壁外性圧排による隆起と虫垂開口部のはち巻きひだを伴う粘膜下腫瘍様隆起を認めた．CT検査では盲腸の外側に低吸収域を含む腫瘍を認め，この腫瘍は腸腰筋に浸潤していた．T₂強調のMR検査でも同部に低信号域が認められ，膿瘍より腫瘍が疑われた．回盲部切除術を施行した．病理組織学的検索では虫垂の粘膜下層以深に2種類の腫瘍細胞がみられ，虫垂漿膜下から隣接する盲腸壁に浸潤していた．第1の細胞は杯細胞に類似し，第2の細胞は通常のカルチノイドの細胞に類似していた．虫垂杯細胞カルチノイドで，術前に本症例のような各種画像検査を行った症例は極めてまれである．

　A 51-year-old man complained of right lower abdominal pain and fever of two weeks' duration. Physical examination revealed a tender and hard fist-sized mass in his right iliac region. The laboratory findings on admission were normal except for leucocytosis, positive CRP and hyperglycemia. Barium enema study demonstrated extraluminal compression of the ascending colon and the cecum, and submucosal tumor of the appendiceal orifice. Colonoscopic examination showed erosions on the elevation seen in the ascending colon and the cecum, and a red elevated appendiceal orifice surrouded by folds. CT scan and MR scan revealed a substantial tumor lateral to the cecum rather than a pericecal abscess. Ileocecal resection was carried out. Pathological examination yielded a diagnosis of goblet cell carcinoid.

　We discussed 36 cases reported in Japan of appendiceal goblet cell carcinoid including our case. CT scan and MR scan are effective for differential diagnosis between an appendiceal tumor and a pericecal abscess.