S状結腸早期癌の1例

A CASE OF EARLY CARCINOMA OF THE SIGMOID COLON

Ⅰ．はじめに

　近年，わが国における胃のX線検査および内視鏡検査は急速に発達し，普及した結果，早期胃癌の診断は軌道にのったといえる．ところが，大腸の診断は胃にくらべて非常に遅れているのが実状のようである．大腸では，胃よりも病変が少ないこともあるが，X線検査法が確立しておらず，また，直腸鏡との協力体制の不十分であることが，大きな障害になっていると考えられる．

　最近，われわれは，早期胃癌の内視鏡学会分類に準じて表現するならば，表面隆起型（Ⅱa）といってもよいような，S状結腸早期癌の1症例を経験したのでここに報告する．

　A man aged forty was referred to Cancer Institute Hospital with the chief complaint of tarry stool which he noticed at the beginning of April, 1968. Proctoscopy in the out-patient clinic (June 11th, 1968) revealed a peanut-sized polypoid growth with two diminutive nodules in the left anterior aspect of the bowel, at about 18 cm away from the anal verge, and biopsy was performed. The patient was admitted on July 5th, 1968.

　In the double contrast radiographs (July 9th, 1968) an irregularly shaped, nodular elevation of the mucosa was clearly demonstrated in the mid-portion of the sigmoid colon, and early carcinoma, what is called superficial, elevated Type (Ⅱa) in that of the stomach, was suspected.

　Histological study of the biopsied material, however, could not confirm the malignancy of the lesion. It was diagnosed as atypical epithelium (borderline case).

　Operation (July 15 th, 1968) was performed on the ground that it could not be determined at present whether the atypical epithelium was malignant or benign, and that the possibility of carcinoma in atypical epithelium or adenoma with carcinoma in situ could not be excluded in this case.

　In the histological study of the resected specimen, the greater part of the lesion consisted of atypical epithelium, but some parts showing intraluminal papillary projection with disorder of nuclear arrangement, abnormal cytoplasma-nucleus ratio, and loss of mucin-secretion were definitely diagnosed as malignant.