小腸・大腸に多発した消化管原発血管肉腫の1例―大腸病変を中心に

Multicentric Angiosarcoma of the Small and Large Intestine, Report of a Case

要旨　患者は74歳，男性．血便を主訴に受診，注腸X線検査および大腸内視鏡検査にて下行結腸に縦走潰瘍を，上部直腸にびらんを認めた．共に生検はGroup 1で，虚血性大腸炎と診断し経過観察となった．しかし血便が続くため，約2か月後に注腸X線検査および大腸内視鏡検査を再検したところ，下行結腸病変は全周性狭窄に進展し，上部直腸病変も更に増大し発赤も強くなっていた．このときの生検もGroup 1であったが，血便が続き貧血も進行するため外科的切除を行った．術中，下行結腸，上部直腸病変以外に，空腸にも隆起性病変を認め，それぞれ局所切除した．術後の病理学的検討にて病変はすべて血管肉腫と診断された．消化管原発の血管肉腫は極めてまれであり，経過を追えたという点においても貴重な症例と考えられたので報告した．

　A 74-year-old man visited our hospital because of bloody stool. Barium enema and colonoscopic examination disclosed a longitudinal ulcer in the descending colon and erosion in the rectum above the peritoneal reflection. Histological examination of the biopsy specimens from both sites showed Group 1. We diagnosed ischemic colitis. But, after two months, barium enema and colonoscopic examination disclosed obstruction in the descending colon and enlargement of the erosion in the rectum. Histological examination of the biopsy specimens showed Group 1 again, but an operation was performed because bloody stool and anemia were persistent. During the operation, an elevated lesion was detected in the jejunum in addition to the ulcer in the descending colon and the erosion in the rectum. All of these lesions were resected locally. As a result of histological examination of the resected specimens, all lesions were diagnosed as angiosarcoma. Primary angiosarcoma of the gastrointestinal tract is very rare, and this case was thought to be valuable from the viewpoint of the observation of changes in these lesions over a period of two months.