Borrmann 2型胃癌を伴ったS状結腸海綿状リンパ管腫の1例と本邦における文献的考察

Lymphangioma Cavernosum of the Sigmoid Colon Associated with Borrmann Type 2 Gastric Cancer, Report of a Case

要旨　大腸リンパ管腫は極めてまれな疾患である．本邦例では第40回日本消化器内視鏡学会関東地方会（1985.6）までに39例40病変が報告されている．最近，注腸X線検査の段階で胃癌（Borrmann 2型）に併存したS状結腸リンパ管腫と読影（診断）した1例を経験したので報告する．患者は64歳，男性（生検でも深達度がm～smのため診断できた宮本例に次いで2例目）．切除標本肉眼所見はSのventに大きさ60×30×20mm，P₃の2峰性の腫瘍で表面平滑，手で圧追すると凹み波動も認める．病理組織学的所見は大小の囊腫状拡張を示した壁の薄いリンパ管増生が粘膜下層にみられ，粘膜固有層にもリンパ管の拡張増生が著明であり内皮細胞の腫瘍性増殖はなく海綿状リンパ管腫と診断した．

　Lymphangioma rarely occurs in the colon. Forty such lesions in 39 patients have been reported in Japan, as of June, 1986.

　We report here 64 year-old man diagnosed by barium enema radiography as having Lymphangioma of the colon in addition to Borrmann type 2 gastric cancer. This was the second case in Japan in which biopsy specimen showed the tumor invading into m, sm, which was the clue to the diagnosis.

　Gross observation of the resected specimen revealed P₃ smooth-surfaced tumor measuring 60 mm by 30 mm by 20 mm, with two raised areas compressible on pressure and pulsation in the ventral wall of the colon. Pathologically, proliferation of the thin-walled lymph vessels with small or large cystic dilatation was seen in the submucosal layer as well as in the lamina propria mucosae. Neoplastic proliferation of the endothelium, however, was not seen.

　Based on these findings, the diagnosis of Lymphangioma cavernosum was made.