著明な低カリウム血症を伴った直腸villous tumorの1例

Villous Tumor of the Rectum Accompanied by Electrolyte Disturbance, Report of a Case

　大腸のvillous tumorは，その特異な肉眼的形態，組織学的特徴，生物学的態度，更には，重篤な水分電解質異常，とりわけ低カリウム血症を伴うことなどの，臨床的，病理学的な特徴により，古くから注目を集めてきた．本腫瘍の報告は，欧米では多数例をまとめたものが数多くみられるが，本邦では報告例も少なく，電解質異常を伴う例はほとんどみられない．

　心電図上にも変化を来し，著明な低カリウム血症を伴った直腸の広範なvillous tumorの1例の概略を述べ，主に臨床的な問題点につき，文献的考察を加え報告する．

　Villous tumor of the rectum with pronounced electrolyte depletion in a 67-year-old woman is described, and the clinical features, pathology and surgical treatment of this condition are reviewed. This tumor with electrolyte imbalance is very rare in Japan.

　The patient complainted of much mucous diarrhea of thirteen years' duration. Occasionally she had had a little bright red rectal bleeding and anal pain on defecation. On digital examination, soft tumor was palpable, which contained underlying areas of induration.

　The hematocrit value was 42%; sodium, 137 mEq/l; potassium, 2.5 mEq/l; chloride, 87 mEq/l; BUN, 20 mg/100 ml; creatinine, 1.1 mg/100 ml.

　Barium enema study revealed a huge villous tumor in the rectum which was nodular, and on double contrast film, a lacework and streaks of contrast media were seen in the crevices.

　Sigmoid-fiberscopic examination showed pallid, nodular and soft mass with secretion of much mucus.

　The Miles operation was performed because the tumor was so extensive as to make local excision impossible and the induration in it could have been invasive malignancy.

　The tumor involved the entire rectal circumference and extended nearly from dentated margin proximally for 19 cm. It demonstrated the numerous characteristic fronds that protruded from the surface.

　Histologically, the specimen composed of elongated, finger-like projections covered with epithelioma which had a core of connective tissue, and in the center of it, the invasive adenocarcinoma was found beneath the muscularis propria.