腸結核に横行結腸癌を合併した1例

Advanced Cancer of the Transverse Colon Associated with Tuberculous Colitis, Report of a Case

要旨　広範な腸結核に潰瘍浸潤型進行癌をみた症例を経験したので報告した．患者は48歳の女性で，主訴はやせと左下腹部痛であった．X線所見では回腸終末部からS状結腸に結腸膨起の消失と瘢痕帯をみた．横行結腸の癌部は，充満像で腸壁の狭小化と伸展性が乏しく，二重造影像でバリウムの付着の異常を認めた．内視鏡所見では癌部に一致して易出血性の粘膜をみた．この部の生検で癌をみた．病理学的所見では回腸終末部からS状結腸に広範なUl-Ⅱs～Ul-Ⅲsの瘢痕萎縮帯をみた．癌巣は腸結核病変の中にあり，癌の深達度は漿膜であり，リンパ節転移を認めた．術後1年8か月で癌再発で死亡した．剖検したが，他の臓器に結核性病変を認めなかった．

　A 48 year-old woman was admitted to our hospital with chief complaints of emaciation and abdominal pain. Radiological examination demonstrated remarkable shortening of the colon between the cecum and sigmoid colon with a long narrowing and no haustration in the transverse colon.

　Endoscopical examination visualized fragile mucosa in the narrowed portion of the transverse colon. The biopsy specimen of this portion revealed adenocarcinoma. In the resected specimen, cancer cells were showed to have infiltrated the whole layer of the colon with lymph node metastasis. This patient died one year and eight months after the operation because of recurrence of the cancer.

　In the autopsy study, there was no tuberculosis in the other organs.