初診時より経過を追い早期癌と広汎なdysplasiaと診断した潰瘍性大腸炎の1例

Early Cancer and Dysplasia Accompanied with Fifteen Years Followed Up Ulcerative Colitis, Report of a Case

要旨　37歳の男性．22歳時（1972年）に全結腸型の潰瘍性大腸炎で発症し再燃寛解を繰り返していたが，1981年ごろからはほとんど症状がなくなった．定期的に経過観察中，1986年11月コロノスコープでS状結腸に1cm大の隆起性病変が発見され，生検で高分化腺癌と診断された．1987年1月，全結腸切除回腸直腸吻合術が行われた。切除標本で癌は粘膜内にとどまる早期癌であったが，癌周囲の広い領域や下行結腸の粘膜にdysplasiaが認められた．dysplasiaを示した粘膜は，コロノスコープでは平坦な粘膜で血管透見像も認められた．本例は潰瘍性大腸炎の初発より経過観察を行い，定期的な内視鏡検査を行った結果，早期癌を発見しえた貴重な症例と考え報告する．

　A 37 year-old man, who was first admitted to our hospital in 1973 with the complaint of bloody diarrhea and a high fever. Barium enema showed the disappearance of the haustra and a granular pattern in the entire colon. Predonisolone and salazopyrin were administered after the diagnosis of ulcerative colitis.

　Recurrence and remission were seen during the first five years. Since 1981 he had been free from symptoms, and since 1983 no medical drug had been administered.

　In November 1986 endoscopic examination showed a small plateau-like tumor and a specimen of it revealed well differentiated adenocarcinoma.

　In January 1987, total colectomy was performed. The resected specimen showed atrophic mucosa of the left sided colon, and an early focal cancer (9×5 mm) in the sigmoid colon.

　Histological findings disclosed well differentiated tubular adenocarcinoma limited to the mucosa.

　Severe dysplasia was found in the flat mucosa around the cancer and descending colon, although its macroscopic findings were normal.

　This case suggests that periodical endoscopic examination in cases of ulcerative colitis makes possible the early diagnosis of its carcinogenesis, and enables surgical treatment to be carried out in a more timely manner.