発症から12年間経過観察中に直腸癌を合併した潰瘍性大腸炎の1例

Ulcerative Colitis with Carcinoma of the Rectum Followed-up for Twelve Years, Report of a Case

要旨　患者は29歳女性，17歳のとき下痢と血便で発症，全大腸炎型の潰瘍性大腸炎と診断し，Predonisolone，salicylazosulphapyridine，造血剤の投与を続けながら12年間当院で経過観察を続けていた．下痢，下血，腹痛，発熱，口内炎などの症状が，ときに出現，この間14回の注腸X線検査を行い，1984年直腸癌の合併と診断し全大腸切除，回腸痩造設術を行い，直腸に浸潤潰瘍型の10.0×7.Ocmの中分化型腺癌を混在し粘液癌を主体とした進行癌を認めた．境界は平坦であった．非癌部の粘膜にも異型を示す病巣がみられた．術後14か月で癌再発により死亡した．

　A 17 year-old woman was admitted to our hospital in 1972 with a complaint of bloody diarrhea. Barium enema studies and colonoscopy revealed typical findings of total colitis. During 12 years, barium enema studies were performed 14 times. Predonisolone and salicylazosulfapyridine were administerd for a long term. In January 1984, she complained of constipation. Latest barium enema studies revealed stenosis and irregularity of the rectum. Rectal biopsy showed adenocarcinoma. Total proctocolectomy was done because of the diagnosis of ulcerative colitis with carcinoma of the rectum. Operative specimen revealed atrophic flat mucosa with advanced rectal carcinoma. Microscopic examination disclosed mucinous carcinoma with moderately differentiated adenocarcinoma and epitherial atypia of the other mucosa. Fourteen months after the operation, she died due to recurrence of the carcinoma.