著明な腸管狭窄を来した結腸malignant fibrous histiocytomaの1例

Malignant Fibrous Histiocytoma of the Colon with Marked Stenosis, Report of a Case

要旨　患者は60歳女性．主訴は左上腹部痛．注腸X線検査において下行結腸上部に狭窄を認めた．内視鏡検査では粘膜に著変はないが，狭窄のため更に口側へは挿入不能であった．以上より結腸腫瘍を疑い手術を施行した．腫瘍は下行結腸のほぼ脾彎曲部に存在し，間膜側を中心にほぼ全周性に浸潤，著明な腸管の狭窄を呈していた．しかし，粘膜面には変化はなく，リンパ節および周辺臓器への明らかな転移も認められなかった．左側結腸切除，脾摘，膵尾部切除および横行結腸S状結腸端端吻合を施行した．腫瘍の大きさは6×3.2×1.4cm，割面は白黄色，漿膜下組織に存在し，一部筋層に浸潤，組織学的にはmalignant fibrous histiocytoma（MFH）であった．術後6か月で右後腹膜に再発を認め，3年6か月後死亡した．MFHは主として四肢および後腹膜軟部組織に発生し，消化管原発のMFHは本例も含め内外で5例の報告があるにすぎない．

The patient of a 60 years old woman complained of the left upper abdominal pain. Barium enema showed a stenosis in the proximal descending colon. Endoscopical examination showed a marked stenosis but no remarkable changes of the mucosa in this portion. By exploratory laparotomy, a tumor was found in the descending colon near the splenic flexure. There was no evidence of regional or distant metastasis, so complete excision was performed. On the resected specimen, the tumor measured 6×3.2×1.4cm and cut surface of the tumor was yellowish-white. Microscopically the tumor was situated mainly in the subserosa and histological diagnosis was malignant fibrous histiocytoma.

There was a massive right retroperitoneal recurrence of the tumor six months after the removal, and the patient died three years and a half after the initial operation. Malignant fibrous histlocytoma is a primitive mesenchymal tumor frequently found in the soft tissues of the extremity and retroperitoneum.

Only four previous reports of this lesion of the gastrointestinal tract are present in the medical literature, and we report the fifth case.