術前診断できた早期回腸癌の1例

Early Carcinoma of the Ileum Diagnosed Preoperatively, Report of a Case

要旨　患者は67歳，男性．上腹部痛で受診し，便潜血反応陽性のため注腸X線検査を施行したところ回盲弁から約20cmの回腸に辺縁不整像を伴う2.5cm大の腫瘤陰影像を認めた．下部消化管内視鏡で同部に粘膜ひだの集中を伴った隆起性病変を認め，直視下生検で高分化型腺癌であった．術前精査のうえ，回腸粘膜下層癌の診断のもと回腸切除術を施行した．切除標本では2.7×2.0cm大の粘膜ひだ集中を伴う凹凸不整な小結節状病変で，病変の辺縁部は軽度に隆起し，中央部には軽度の陥凹をみた．組織学的には粘膜内を主体とする高分化型腺癌で，一部粘膜下層のリンパ管内に大量に浸潤していた。腺腫成分は認めなかった．術前に組織学的確診および深達度診断できた早期回腸癌症例は極めてまれである．

　A 67-year-old man consulted a hospital because of epigastric pain. Fecal occult blood was positive and barium enema carried out. An irregularly shaped tumor shadow was disclosed at the ileum on the oral side 20 cm from the ileocecal valve. Total colonoscopy performed as far as to the ileum and an elevated lesion with converging mucosal folds was shown. Endoscopic biopsy revealed a well differentiated adenocarcinoma. Under a diagnosis of early cancer of the ileum, partial resection of the ileum was undertaken. The resected specimen showed an uneven granular mucosal lesion, 2.7×2.0cm in size, with converging mucosal folds and slight marginal elevation and slight central depression. Histologic examination demonstrated a well differentiated adenocarcinoma whose invasion was mostly limited to the mucosa, but was partly seen extensively in the submucosal lymphatic vessels. No adenomatous component was demonstrated. Early cancer of the ileum diagnosed preoperatively is very rare.