回盲部変形を来した大腸結核・大腸癌併存の1例

Colonic Tuberculosis with Carcinoma, Report of a Case

　大腸癌の増加が言われているが，結核性大腸炎と大腸癌の合併症例の報告は少ない．われわれは，30年前に結核性腹膜炎を経験した63歳女性に狭窄型上行結腸癌と，隣接した上行結腸に多発瘢痕を認め，壁在リンパ節には結核性肉芽腫と結核菌を証明した1例を経験した．回盲部変形を来しており，診断にも一時迷いを生じたので報告する．

　A 63-year-old woman complaining of intermittent abdominal pain was admitted to our hospital on October 1, 1981. In her past history, 30 years before, she had three times admission for tuberculous peritonitis.

　Barium enema x-ray study showed abnormal stricture of ascending colon and marked shortening of right side colon with multiple scars caused by tuberculous colitis. Endoscopic study revealed well-differentiated adenocarcinoma in the discolored and friable mucosa at the marked narrowing region of the ascending colon. There were many scars and pseudodiverticula in the right side colon.

　Right side colectomy was performed on October 14, 1981. The specimen consisted of 33 cm of the right side colon and terminal ileum. Situated in the mid portion was an anular tumor which extended over 5 cm of the bowel almost completely occluding the lumen. On longitudinal cut section the tumor extended into the outer muscular layer and adjacent fat tissue without marked excavation of the bowel surface. A histological diagnosis of well-differentiated adenocarcinoma type Ⅲ with no lymphatic metastasis was made.

　Postoperative course was uneventful for about one year. And we discovered many minimal sized coin-lesions in her chest x-ray film in August 1982. She died on June 1, 1983 due to difficulties of breathing caused by secondary lung cancer. Autopsy was performed. It was concluded that the patient had died primarily of the consequences of multiple metastatic lung cancer. And there was no evidence of recurrence of carcinoma in the abdominal cavity, and her liver was free from tumor metastasis.

　And we reviewed 31 cases of colonic tuberculosis with cancer in Japan. The female outnumbered the male with a ratio of 1 : 2.4. Age distribution way 32 to 75 years. The mean age was 56.2 years. The locations of cancer were: cecum 11, ascending colon 7, transverse colon 6, descending colon 3, sigmoid colon 3, and rectum 1 case.

　There were some difficulties in making a diagnosis of simultaneous tuberculosis and carcinoma of the colon by x-ray or endoscopic examination, because such a carcinoma does not have clear-cut margin and marked central excavation.