限局性腹膜偽粘液腫を形成した虫垂粘液性囊胞腺癌の1例

Localized Pseudomyxoma Peritonei Associated with Mucinous Cystadenocarcinoma of the Vermiform Appendix, Report of a Case

　原発性虫垂癌は50歳台，60歳台の癌年齢に発生することが多いが，今回われわれは29歳の男子に発生し，限局性の腹膜偽粘液腫を形成した虫垂粘液性囊胞腺癌の1例を経験したので報告する．

症　例

患　者：29歳，男性，

主　訴：回盲部痛．

家族歴：特記すべきことなし．

既往歴：9歳時，腹膜炎として入院したことがある．

現病歴：1981年7月初めより時々回盲部痛があり，同部の圧痛を自覚していた．7月17日，悪寒，熱発などはないが同部にかなりの疼痛があり某医を受診，白血球増多（9,900）および回盲部に手拳大の腫瘤を指摘され抗生物質の投与にて軽快した．7月21日，経口小腸大腸造影検査にて回腸末端部に腫瘤による圧排所見と，不整の縦長の潰瘍を思わせる陰影が認められ，7月23目精査のため当科を紹介され入院となった．この間，便通および便の性状には特に変化を認めなかった．

　A 29 year-old man was referred and admitted to our hospital after visiting his doctor because of ileocecalagia and noticing tenderness on the ileocecal region. The doctor found a tumor the size of a man's fist there.

　Barium enema study did not visualize the appendix and the medial side of the cecum was compressed in a hemispheric way probably due to an extracolonic mass. Colonofiberscopy revealed two ulcerative lesions on the medial side of the cecum. We could not find the orifice of the appendix. Surgical intervention under a preoperative diagnosis of perityphlic abscess disclosed a tumor greater than a man's fist behind the cecum, ileum and the mesentery. Ileocolectomy was done including the tumor mass. At the time of separation there was a flow of mucoid substance. Histologically, mucinous adenocarcinoma was seen not only in the muscular layer but partly involving the serosa as well. A faily great amount of mucus was seen in the villi and cytoplasms. Macroscopically, no metastasis was recognized either to the liver, lymph nodes or other parts of the peritoneum. The tumor could be called either localized pseudomyxoma peritonei or malignant mucocele.