小児結腸癌の1例ならびに小児結腸癌本邦報告例の検討

Carcinoma of the Colon in Children

　本邦における結腸癌の発生頻度は胃癌，直腸癌に次いで多く，全消化管癌の4％，大腸癌の30.5％と報告されている¹⁹⁾．30歳以下の若年者結腸癌は，同一施設の報告では全結腸癌の2.5％である²⁰⁾．しかし15歳以下の小児結腸癌はまれで，本邦報告例は18例にすぎない．最近，われわれは14歳男児結腸癌の1例を経験したので報告する．

　症　例

　患　者：14歳，男児．

　入院時主訴：便秘，腹痛ならびに嘔吐．

　家族歴：父親は35歳時に，父方の祖父は40歳代で，共に胃癌のため死亡．父の同胞6名中，妹が40歳時に乳癌で死亡．母方には血族中の癌患者はない．

　既往歴：患児は8歳時に心臓カテーテル検査の結果，大動脈縮窄症ならびに左総頸動脈，左鎖骨下動脈起始部形成不全（狭窄）による，subclavian stealと診断され，同年coarctotomyを受けた．術後経過は順調であった．

　A 14-year-old boy was admitted because of abdominal pain, vomiting, and constipation which he had for one week. Some members of his family had died of malignancy: his father and his grandfather died of stomach cancer and one of his aunt died of breast cancer. He had a congenital heart disease, i.e., coarctation of the aorta. Coarctotomy was done when he was eight years old. Present illness started five months before admission, when he had acute postprandial pain accompanied with nausea. Two months later, he visited a doctor with a complaint of easy fatigability. Hematological examination revealed hypochromic anemia and stool test showed positive occult blood. He had an x-ray of the upper GI tract which revealed no abnormality. After admission, he showed an increasing sign of ileus. Barium enema disclosed complete obstruction at the splenic flexure. The next day, examination by colono-fiberscope found an edematous, annular and constricting lesion. Biopsy specimens were obtained, which suggested malignancy. Radical operation was performed five days after admission. At laparotomy, cancer of the splenic flexure was found without metastasis to peritoneum and liver. Histopathologic examination revealed a moderately differentiated adenocarcinoma not metastasizing to epi- and para-colic lymph nodes. Combination chemotherapy using MMC, 5-FU and PS-K was started two weeks later. He was discharged five weeks after operation and he is doing well ten months postoperatively. 18 cases of colon cancer in children were collected from Japanese literature. The prognosis is unfavorable. Radical operation was done in 15 cases, but follow-up study disclosed 12 cases of postoperative death. Only one case of mucoid cancer survived for more than five years.