表層拡大型様進展を示した横行結腸sm癌の1例

Superficial Spreading-Type Adenocarcinoma of the Transverse Colon, Report of a Case

要旨　患者は58歳，男性．1992年6月13日当院ドックで大腸内視鏡検査を行い，横行結腸の陥凹性病変を指摘された．注腸X線検査では，同部にひだ集中を伴う不整形陥凹を認め，その周囲に広範な地図状不整形の透亮像を認めた．大腸内視鏡検査では，横行結腸に約1/2周にわたり，中央にひだ集中を伴う明瞭な陥凹を有し，周囲にわずかに陥凹したⅡc様部分，ほぼ平坦なⅡb様部分，わずかに隆起したⅡa様部分からなる広範な発赤した病変を認めた．生検で高分化型腺癌との診断を得て9月7日手術を行った．切除標本の病理学的検索の結果，病変は腫瘍腺管の側方進展（全層性ないし一部表層性）の著明な大きさ46×43mm，深達度smの高分化型腺癌でⅡc，Ⅱb，Ⅱa様部分からなる表層拡大型様の形態を示す病変であった．

　The patient was a 58-year-old male. When he received a thorough physical checkup on June 13, 1992 at our hospital, colonoscopic studies revealed a depressed lesion in the transverse colon. On barium enema x-ray examination the same site was found to have an irregular depression with converging folds. It was surrounded by extensive map-like irregular translucency. On colonoscopic examination the lesion was found to be as large as half the circumference of the colon. The lesion had a marked depression with converging folds at its center and was surrounded by extensive erythemas consisting of a slightly depressed Ⅱc-like area, a nearly flat Ⅱb-like area, a slightly elevated Ⅱa-like area. With a diagnosis of well differentiated adenocarcinoma made by biopsy, surgery was performed on September 7. Pathological examination of a histologic section showed that the lesion was a well-differentiated sm adenocarcinoma measuring by 46 by 43 mm showing vigorous lateral growth (circumferential or superficial) of tumor glands. The lesion consisted of Ⅱc-, Ⅱb-, and Ⅱc-like areas and was of the superficial spreading type.