大腸原発のびまん性浸潤癌の1例

Diffuse infiltrative Carcinoma of the Colon, Report of a Case

　大腸におけるびまん性浸潤癌（linitis plastica型癌）はまれとされている．最近，われわれは大腸原発のびまん性浸潤癌の1例を経験したので若干の文献的考察を加え報告する．

　Diffuse infiltrative carcinoma of the colon is rare and only 50 cases have been reported during the period of 1975 to 1981. Average age is 49.7 years old and man and woman ratio is 29:21. 70％ of the patients died within six months after the operation.

　A patient, 63 year-old man was admitted with complaints of abdominal pain and distention.

　Physical examination: An elastic hard mass of the size 5×15 cm was palpable in the left lower quadrant of his abdomen.

　Barium enema: A stenotic area as long as 20 cm with spiculation and cobblestone-like appearance of the mucosa between descending and sigmoid colon were seen.

　Colonoscopy: Stricture was observed at 33～35 cm from the anal verge and fiberscope could not pass through. Biopsy specimens showed poorly-differentiated adenocarcinoma.

　Operative findings: The tumor invaded into the retroperitoneum and around ureter and urinary bladder (N₃, P₃, H₀).

　A part of the descending and sigmoid colon has been resected (R₀).

　Macroscopically, resected specimen showed a severely thickened wall with fibrosis and invasion of the carcinoma between descending and sigmoid colon, which is about 20 cm long. And at the most stenotic part, there was a shallow ulceration as large as 1.5×2.0 cm. There was a pedunculated polyp 8 cm proximal from the lesion.

　Histologically, poorly-differentiated adenocarcinoma has been observed. Scirrhous thickening of the wall has been constituted by predominant fibrosis accompanied by the carcinomatous infiltration through venous and lymphatic systems (lymphangitis carcinomatosa).

　The patient died of carcinomatous peritonitis seven months after the operation.