陳旧性腸結核に大腸癌を合併した1例

Carcinoma of the Ascending Colon Associated with Healed Colonic Tuberculosis, Report of a Case

要旨　患者は，79歳，男性で便潜血陽性を主訴に来院．注腸検査，大腸内視鏡検査で，盲腸部の偽憩室形成，上行結腸の短縮を認め，陳旧性腸結核が疑われ，また，上行結腸肝彎曲部に粘膜集中を伴う陥凹性病変を認めた．生検の結果，中分化腺癌と診断され，右半結腸切除術が施行された．切除標本では，上行結腸肝彎曲部に大きさ35×30mmの潰瘍浸潤型の病変を認めた．癌の組織型は中分化腺癌が主体で一部未分化像を示し，深達度は漿膜下層までであった．切除標本の全割検索により，上行結腸から盲腸部にUl-Ⅲの潰瘍瘢痕と，癌の近傍にUl-Ⅱの潰瘍瘢痕を認めた．乾酪性，非乾酪性肉芽腫は認められず，異型上皮も認められなかった．

　A 79-year-old man visited our hospital with the complaint of occult blood in his stool. Barium enema and endoscopic examination revealed marked shortening of the ascending colon. Multiple pseudo-diverticula due to multiple ulcer scars were recognized in the cecum. On the distal ascending colon (hepatic flexure), a depressed lesion was observed. Biopsy specimens taken from this lesion revealed moderately differentiated tubular adenocarcinoma. Because of this, right hemicolectomy was performed. In the macroscopic findings of the resected specimen, a depressed lesion with low randwall and with converging folds was observed in the distal ascending colon. Histologically, the cancer was mainly moderately differentiated tubular adenocarcinoma, but partially, it showed undifferentiated carcinoma. Some ulcer scars (Ul-Ⅲ and Ul-Ⅱ) were seen in the ascending colon, but no tuberculous granulomas or atypical epithelium was observed.