腸重積を起こした回腸細網細胞肉腫の1例

A Case of Reticulum Cell Sarcoma of the Terminal Ileum showing Intussusception

　消化管に発生する悪性腫瘍の大部分は癌腫であり，肉腫は比較的稀である．われわれは回盲部に腸重積様陰影を呈した回腸末端部原発の細網細胞肉腫を経験したので報告する．

症例

　患　者：72歳　男性　農業

　主　訴：粘血便

　家族歴：姉・弟，肺結核にて死亡

　既往歴：15歳，腸チフス

　現病歴：朝食約1時間後に嘔気，嘔吐，腹部全体のとう痛をきたし，少量の粘血便をみた．近医にて鎮痛剤の投与をうけ，症状は軽減したが，翌日にも同様のとう痛と粘血便をみたため当院を受診した，食思不振はあったが，発熱，体重減少はなかった．

　A man aged 72 complained of mucoid and bloody stool along with nausea and vomiting. The ileocecal region was slightly tender, The feces was positive for occult blood. There were also anemia and slight decrease in renal function. Barium enema study disclosed a shadow defect and a picture of protrusion in the ileocecal region, suggestive of intussusception. Repeat barium enema study one week later showed disappearance of the tumor in the ileocecal region. A tumor slightly indented and of uneven, irregular surface was detected instead in the terminal part of the ileum. Endoscopy (CF type LB) and biopsy were attempted, but the tumor had grown large enough to occlude almost the whole lumen of the ileum. There was not enough room for sufficient endoscopic observation except the sides of the tumor. Biopsy was also of no avail in obtaining the qualitative diagnosis of the neoplasm, allowing us only to suspect the presence of either leiomyosarcoma or malignant lymphoma. Right hemicolectomy showed a solitary tumor,40×40×16 mm in dimensions, at a site 3 cm oral from the ileocecal valve. Infiltration of tumor cells reached the subserosa, invading the regional lymph nodes as well. Histologically the tumor was reticulum cell sarcoma of the ileum.

　The patient is in good health as of 17 months after the surgery.