Crohn病に合併した肛門直腸粘液腺癌の1例

Mucinous Adenocarcinoma of the Rectum Associated with Crohn's Disease, Report of a Case

要旨　患者は31歳，女性．15年来の痔瘻と8年にわたるCrohn病の病歴を有し，肛門部痛，肛門出血を主訴に来院した．肛門部には通常のskin tagとは様相の異なる褐色調の巨大な結節状隆起を認め，腫瘤近傍の正常と思われる皮膚にも圧痛を伴う硬結が見られた．注腸X線検査では，肛門輪から約10cmにわたり全周性の狭窄を認め，3型大腸癌と診断した．肛門部腫瘤および大腸病変部の生検で粘液腺癌と診断し，骨盤内臓器全摘出術を施行した．切除標本の病理学的検索と病歴，臨床所見から，本例はCrohn病の痔瘻から発生した粘液腺癌と考えられた．本邦におけるCrohn病に合併した大腸癌の報告は本例が4例目である．

　A 31-year-old woman who had a 15-year history of Crohn's disease with anal fistula was referred to our hospital with the chief complaint of anal pain and anal bleeding. She had a prominent nodular anal skin tag. Induration with tenderness was observed at the region of the previous opening of the external fistulous track. By barium enema radiogram of the rectum an abrupt circumferential narrowing as far as 10 cm from the anus was diagnosed as anorectal cancer. Histology of the biopsy specimens of the anal skin tag and the colonic lesion disclosed mucinous adenocarcinoma. The anorectal and skin lesions were completely resected. From the histological findings and the long history of anorectal lesions, this case is considered to be a typical case of anorectal cancer derived from long-term perianal fistula with Crohn's disease.