特異な“きのこ雲状”注腸像を示した横行結腸原発びまん浸潤型粘液癌の1例

Diffusely Infiltrative Mucinous Carcinoma of the Transverse Colon: An Unusual “Mushrooming Cloud”-like Appearance on Barium Enema Examination, Report of a Case

要旨　患者は64歳，女性．発熱，下痢，左上腹部痛，嘔気を主訴とし来院．上部消化管X線検査で胃体部大彎に管外よりの圧排所見を認め当科入院．注腸造影で横行結腸肛門側に約13cmにわたって粘膜ひだの肥厚したなだらかな管腔狭小化像と，その中央部の約1.5cm大の潰瘍に引き続く特異な“きのこ雲状”陰影を認めた．炎症反応強陽性，抗生物質の有効性より膿瘍など炎症性疾患との鑑別に苦慮したが，横行結腸原発の癌を疑い開腹すると，同部より頭側に浸潤し胃体部，脾門部に癒着する大きな腫瘤形成を認めた．開腹術約3か月後に死亡．剖検では組織学的に著明なリンパ管侵襲を伴う横行結腸原発びまん浸潤型粘液癌であり，腫瘍塊の内部には注腸時のバリウム，糞塊の残存が認められた．

　A 64-year-old woman was admitted to our hospital with complaints of fever, diarrhea, left upper abdominal pain and nausea. Upper GI x-ray examination revealed compression of the greater curvature of the gastric body. A barium enema examination disclosed a long narrow segment approximately 13 cm in length with markedly thickened and tortuous mucosal folds in the distal transverse colon. In the center of the narrow segment, there was a 1.5 cm ulcer with fissurization producing “a mushrooming cloud”-like appearance. It was difficult to exclude inflammatory disease such as an abscess, because of severe associated inflammation and clinical improvement with antibiotics. At her operation, however, a large mass was palpable in the distal transverse colon, invading the greater curvature of the gastric body and spleen, and multiple peritoneal implants were observed. Palliative by-pass operation was performed and the patient died three months later. At autopsy, microscopic examination of the tumor in the transverse colon showed diffusely infiltrative mucinous adenocarcinoma with marked lymphatic invasion. In addition, retained barium and a fecal mass were seen within the tumor.