腸結核に合併した上行結腸癌の1例

Carcinoma of the Ascending Colon Associated with Tuberculous Colitis, Report of a Case

　われわれは腸結核に上行結腸癌の合併がみられたまれな症例を経験したので，そのX線内視鏡所見を中心にして報告する．本症例の大腸癌は，一般にみられる大腸癌と少し形が異なっていたので，腸結核に合併した大腸癌の形態的特徴について，報告例を集め検討した．

症　例

患　者：山○サ○，62歳女性．

主　訴：嘔吐．

既往歴：左乳癌手術（13年前）．

家族歴：特になし．

現病歴：1981年11月18日夕食後，突然2回嘔吐した．近医を受診し，胃X線検査を受けたが異常所見は認められなかった．下腹部痛，下痢など腸疾患を疑う症状はなかったが，注腸X線検査を受けたところ異常所見があり本院を紹介された．

　A 63 year-old woman with a chief complaint of nausea was referred to our hospital for detailed examination of the colon. She had already been found to have abnormal findings in barium enema study at a certain clinic. Physical and laboratory examinations revealed no abnormality.

　Radiological examination demonstrated an applecore lesion in the ascending colon. A circular narrowing with tiny niches and polyps was found in the proximal descending colon. The transverse colon was shortened with abnormal barium-coating. These radiological findings ensured the diagnosis of colon cancer accompanied by intestinal tuberculosis.

　Endoscopic examination visualized a flat, soft, gyrus-like elevated mass at the distal site of the apple-core lesion. This finding differed from the appearance of typical colon cancer. The biopsy specimen of this lesion however revealed adenocarcinoma. Multiple, irregular-shaped ulcers with white coating and small polyps were seen circularly in the narrowed lumen of the ascending colon.

　The operated material showed a flat, large protruded carcinoma, measuring 8×6 cm in the ascending colon. Small depressions and small inflammatory polyps were revealed in the atrophic mucosa of the transverse colon and splenic flexure. These findings were associated with tuberculosis.

　The histological type of colonic cancer was well-differentiated adenocarcinoma. Cancer partly invaded the subserosal layer. Some tuberculous granulomas were found under the cancerous mucosa in the ascending colon.

　The case of colonic cancer associated with intestinal tuberculosis is extremely rare. The macroscopic appearance of this cancer differs from that of typical colonic cancer which is similar to the type of gastric cancer, Borrmann 2. According to the literature, macroscopic findings of this cancer resemble closely the type of cancer associated with ulcerative colitis.