花壇様隆起を示した大腸腺管腺腫の1例

A Case of Flower-bed-like Tubular Adenoma

　大腸ポリープのうち，花壇様隆起を示すものは比較的まれである．今回，40×38×3mmの花壇様隆起を示す腺管腺腫を経験したので報告する．

症例

　患　者：53歳　女性　主婦

　主　訴：右下腹部痛

　家族歴：父は胃癌，母は子宮癌で死亡している．3人の子供のうち，長男が24歳の時，結腸癌で死亡している．

　既往歴：特記すべきものはない

　現病歴：生来健康であったが，1975年に長男が結腸癌で死亡した頃より，時々軽度の右下腹部痛を覚えるようになり，大腸X線検査などを受けたが，その時は異常を指摘されなかった．しかしその後も右下腹部痛が持続するため，1976年1月27日本院内科を受診，外来で大腸X線検査を受けたところ，下行結腸に異常所見を指摘され，精査のため入院した．血便，便通異常などは自覚していない．

　A 53-year-old woman was admitted to our hospital with a complaint of lower abdominal pain of five months’ duration. In her family history, parents and their son died of cancer of the stomach, uterus and colon respectively.

　Laboratory examinations on admission showed no abnormalities. Barium enema and colonoscopy showed a large, flat and sessile protruded lesion in the descending colon without eroded surface.

　Biopsy specimens revealed tubular adenoma with moderate atypia. She had a sudden attack of cerebral stroke on the 9th day after admission, followed by left-side paralysis. She died of middle cerebral artery occlusion fifteen days after the onset of her illness.

　At autopsy, resected specimen of the descending colon showed a flower-bed-like protruded lesion, 40×38mm in size.

　Histologically this lesion showed a tubular adenoma with unequal atypia. A few cases of flower-bed-like tubular adenoma have been reported up to now, which were smaller in size or accompanied with malignant change.

　This is the first case which grew over 2cm in diameter and histologically showed no malignancy.