腸結核に合併した横行結腸癌の1例

Carcinoma of the Transverse Colon Associated with Tuberculous Colitis, Report of a Case

　われわれは腸結核と大腸癌の合併したまれな症例を経験したので報告する．この症例の大腸癌の肉眼所見は通常みられる大腸癌の形と少し異なっていたので，この点に注目し腸結核や潰瘍性大腸炎に合併する大腸癌の形態的特徴について若干の文献的考察を試みた．

　A 66-year-old woman with a chief complaint of nausea was referred to our hospital for further detailed examination of the colon. The plain roentgenogram of the abdomen revealed multiple air-fluid levels.

　Radiological examination demonstrated the remarkable shortening of the entire colon, and the gradual, long narrowing in the proximal transverse colon. This gradual, smooth, narrowed segment apparently differed from that of typical colonic cancer radiologically. Our previous experience, however, with a similar case in which identical x-ray findings had been found as a form of colon cancer accompanied by chronic inflammatory bowel disease enabled us to diagnose this case as colon cancer accompanied by intestinal tuberculosis.

　Endoscopical examination visualized uneven mucosa in the distal site of the stenosis of the transverse colon. This finding differed from the appearance of typical colon cancer. The biopsy specimen of this lesion, however, revealed adenocarcinoma.

　The surgical material showed 10 cm long constricted colon cancer.

　Histologically, cancer cells infiltrated through the whole layers of the colon, invading the surrounding adipose tissues. This cancerous invasion made a large tumorous mass. A tuberculoid granuloma was observed in the cancerous tissue. The histological type of colonic cancer was well-differentiated adenocarcinoma with the appearance of mucus-producing carcinoma.

　The incidence of colonic cancer associated with intestinal tuberculosis is extremely rare. The macroscopic appearance of this cancer differs from that of typical colonic cancer which is similar to the type of gastric cancer, Borrmann type 2.

　It has been reported that colon cancer in patients with ulcerative colitis often presents the so-called constricting type of colon cancer found in the present case. It can be concluded, therefore, that the type of colon cancer in the case presented is characteristic of colon cancer associated with chronic inflammatory bowel disease.