腸結核の合併がみられた原発巣不明の小腸・大腸癌の1例

Carcinoma Arising from the Colon and Ileum Complicated with Ileal Tuberculosis, Report of a Case

要旨　腹部膨満感を訴え，74歳の女性が来院した．横行結腸に下掘れ潰瘍がみられ，その周辺粘膜は不整に結節状に隆起していた．回腸にも2か所にわたってapple-core様の狭窄性腫瘍が指摘された．そして回腸の2つの腫瘤の間の粘膜にはKerckring皺襞が失われ，線状潰瘍ないし瘢痕，偽憩室がみられた．切除材料の病理組織学的検索でも，大腸，小腸の病巣ともに低分化腺癌であり，いずれが原発巣か，あるいは重複癌であるのか確定診断はできなかった。更に回腸癌の周辺には腸結核の所見もみられ，癌と結核との因果関係についても興味が持たれた．

　A 74 year-old woman visited our hospital complaining of abdominal distension. Barium enema study revealed a punched-out ulcer with irregular margin surrounded by polypoid lesions at the transverse colon. X-ray examination of the small intestine also disclosed two lesions presenting apple-core sign in the ileum. Linear ulcer and/or scar and pseudodivertcula were observed on the mucosa between two lesions where Kerckring's folds were lacking. Histological examination of the resected specimens from the colon and ileum yielded the same histological diagnosis of poorly differentiated adenocarcinoma; however, it could not be determined whether they were primary lesions and its metastatic foci or triple cancer. Cancer cell emboli were observed in the veins and lymphatics just beneath the linear ulcer of the ileum, and non-caseating granuloma with Langhans' giant cells were revealed near the ileal cancer which were the typical histological findings of tuberculosis of the ileum.