Colitis ulcerosaと癌の合併症例

Ulcerative Colitis and Cancer, Report of a Combined Case

　潰瘍性大腸炎は従来欧米に多く，わが国には少ない疾患とされていたが，最近増加の傾向があり，わたくしどもはすでに44例を経験している．なお潰瘍性大腸炎の癌化例はわが国では欧米に比較してはるかに少ない．

　我々は臨床的に原発巣を決定しえなかった癌性腹膜炎の患者を剖検して，これが潰瘍性大腸炎の癌化によるものと考えられる1症例¹⁾²⁾を経験したのでその概略を報告する．

　A report is made of a patient died of carcinomatous peritonitis for which it was impossible to find out the primary site of cancer. Later canceration of ulcerative colitis proved to account for it.

　A 50-year-old housewife had complained of diarrhoea and abdominal pain since April 1960. In March of the following year her sense of fullness in the abdomen was such that she was at last hospitalized on May 19. At admission, a tumor the size of an infant's head was palpated from under the left costal margin down to the lower abdomen. As tumor cells were demonstrated in the ascites, a diagnosis of carcinomatous peritonitis was made. However, we could not find out the origin of cancer. In the meantime her physical condition became worse day by day and she died on Sept. Autopsy was performed, and carcinomatous peritonitis was demonstrated. The small and large bowels formed a conglomerate, occupying the whole left part of the abdominal cavity. Except for the rectum the colon showed in its entire length innumerable ulcers of uneven size, forming a geographical pattern. No pseudo-polyp was noticeable. Ulcers in the colon were highly undermined, their bases reaching the muscular layer, Inflammatory cellular infiltration showing exsudate, degeneration and necrosis was demonstrated in the ulcer floors.

　Histological study of a certain segment of the involved colon disclosed tubular tumorous tissue showing mitosis and atypicality of its cells. Infiltration was pronounced from the ulcer margins to the submucosa. It would be unadvisable to assume at once that this picture represents a tissue in a precancerous condition. Had marginal portions of this segment been investigated further, definite cancer tissue could have been detected. Inefficient sectioning process prevented us from detailed study.

　Almost an identical case had already been reported by Goldgraber in 1958, who studied canceration in ulcerative colitis. Presumably our case also belongs to it.

　Ulcerative colitis is now being encountered in an increasing number in our country too, and so far we have experienced 44 cases of it. While its canceration attracts great attention abroad, only a few reports have been made in Japan. In coming across patients with ulcerative colitis we shoud follow them up on a long-term basis, and its possible canceration must always be taken into account.