直腸平滑筋肉腫の1例

Rectal Leiomyosarcoma

　消化管平滑筋肉腫のうちでも直腸病巣は臨床上極めてまれで，本邦では岩井ら¹⁾（1955年）の第1報以来，1977年までに45症例の報告²⁾がみられる．著者は直腸平滑筋肉腫の1例を報告するとともに直腸本症の特異性について診断面を中心にして考察を加えてみたい．

　症　例

　患　者：56歳，男，鉄工員．

　主訴：便通異常．

　家族歴：特記すべきことなし．

　既往歴：36歳時虫垂切除．

　現病歴：約半年前より下腹部の軽度膨満感と尿意頻回などの症状を自覚していた．排便は1日1行であったが来院10日前より下痢と便秘を繰り返すため来院．肛門出血やとう痛および便柱狭小などは，全く自覚していなかった．

　The patient, a 56 year-old male, had suffered from alternating diarrhea and constipation.

　Digital examination of the rectum revealed a hard mass. Barium enema showed marked narrowing of the ampullar region of the rectum. Endoscopically, a semispherical tumor like the submucosal one with bridging folds was observed on the left lateral wall of the rectum, located about 4 cm from the anus. But, bleeding, erosion and ulceration could not be observed in its center.

　Biopsy specimen taken from the submucosal tumor by means of enucleation was diagnosed as leiomyosarcoma, histologically.

　Then, radical operation (abdomino-perinear resection) was carried out. Cut surface of the resected tumor measuring 8.5×6.5×3.5 cm showed typically exophytic growth.