DALMとは離れた平坦粘膜部に浸潤癌（sm癌）が認められた1例

DALM (Dysplasia Associated Lesion or Mass) Complicated with Submucosal Invasive Carcinoma in the Flat Mucosa in Ulcerative Colitis, Report of a Case

要旨　患者は65歳，男性．全大腸炎型の潰瘍性大腸炎と診断され，発症後6年目に当科を受診．外来通院治療を続け，翌年の発症後7年目からサーベイランス内視鏡検査を開始した．発症後8年目のサーベイランス内視鏡検査にて，S状結腸にDALMを認めたため手術を施行した．患者の希望により，結腸左半切除術を施行した．切除標本にて，DALMの部分には癌を認めなかったが，DALMとは離れた平坦粘膜部に浸潤癌（sm癌）が認められた．組織型は，高分化～中分化腺癌で，静脈侵襲，リンパ管侵襲は認められず，リンパ節転移も認められなかった．術後，5年経過した現在も，再発は認められず，また残存大腸のサーベイランス内視鏡検査でもdysplasiaは認められていない．

　A 65-year-old man underwent surgery because DALM was detected by surveillance colonoscopy. The patient was referred to the University of Tokyo Hospital in 1994 with a diagnosis of extensive ulcerative colitis, six year after the onset of the disease. Surveillance colonoscopy was started from 1995. In 1996, biopsy specimens from the polypoid lesion in the sigmoid colon revealed dysplasia, which was considered to be a DALM. Therefore, surgical resection of the large bowel was perfomed. At the patient's request, left colectomy was performed. Pathological examination of the surgical specimen revealed no invasive carcinoma in the lesion of DALM, but invasive carcinoma apart from DALM was observed. There was no venous or lymphatic invasion. No lymph node metastasis was observed either. The patient has had no recurrence during the five years since the operation. Neither has surveillance colonoscopy revealed dysplasia during the same period.