S状結腸の径8mmのⅡa様ss癌の1例

Small Advanced Carcinoma of the Sigmoid Colon, Report of a Case

要旨　患者は38歳，男性．1991年6月，人間ドックにて便潜血反応陽性を指摘された．8月27日，大腸内視鏡でAVから40cmにⅡa様病変を認めたが，生検は高度異型腺腫であったため，10月15日，strip biopsyを施行（大きさ8×7×5mm）．その結果，well differentiated adenocarcinoma，core invasion（＋），surgical margin（＋）であったので11月25日，S状結腸切除術を施行．組織学的には腸管壁に癌遺残を認め，特に脈管侵襲のため，ssの深達度であり，1群リンパ節にも転移を認めた．1年2か月後，肝，腹膜再発を来した．以上，本症例は腫瘍径8mmにもかかわらず，深達度ss，リンパ節転移陽性であったまれなS状結腸癌の1例であった．

　A case of a small advanced carcinoma of the sigmoid colon is reported. A 38-year-old man presented to the Aichi Cancer Hospital on August 20, 1991 with a chief complaint of positive fecal occult blood test. Colonoscopic examination revealed a small flat elevated polyp in the sigmoid colon. The biopsy specimen showed tubular adenoma with severe atypia and endoscopic strip biopsy was performed. The specimen, 8×7×5 mm in size, was microscopically diagnosed as well differentiated adenocarcinoma with core invasion and positive surgical margin. He underwent sigmoidectomy. The resected specimen revealed moderately differentiated adenocarcinoma which remained in the colonic wall and invaded the subserosal soft tissue through vessel invasion. Fourteen months after the operation, hepatic and peritoneal recurrence was found.