右半結腸結核に併存した結腸癌の1例

Colonic Carcinoma Associated with Tuberculous Colitis, Report of a Case

要旨　71歳の女性，腹痛と腹部腫瘤を主訴として来院．大腸X線所見において回盲部から右側横行結腸にかけての短縮，狭窄ならびに炎症性ポリープの所見より結核の診断を，狭窄の口側寄りの腫瘤陰影より癌併存の疑診を得た．切除標本では深いクレーターや周堤がなく，粗大な結節状腫瘤と浅い潰瘍と炎症性ポリープを認めた．組織学上，癌は粘液産生性の高分化腺癌で，筋線維束を分け入るように漿膜下層まで浸潤していた．結核は癌の周辺と深部にみられ，著明な線維化と多数の肉芽腫を認めた．自験例と腸結核に癌を合併したこれまでの報告例より，本症には特徴ある肉眼ならびに組織学的所見を有することを指摘し，結核と癌の因果関係について考察を行った．

　A 71 year-old woman visited our hospital complaining of abdominal pain and mass. Double contrast radiograph showed a marked shortening and narrowing of the right side colon. Tumorous shadow was shown in the proximal portion of the narrow segment, and inflammatory polyps were evident in the distal portion. Right hemicolectomy was performed after a diagnosis of colonic tuberculosis with suspicion of accompanying colonic carcinoma.

　Resected specimen revealed constricted narrow segment, 10 cm in length with proximal protruded lesions and distal inflammatory polyps. The histological examination showed well-differentiated mucus-secreting adenocarcinoma penetrating the muscle layer and infiltrating as far as the subserosa. Adjacent to the colonic carcinoma there was tuberculous inflammation with dense fibrosis and numerous epithelioid cell granulomas located mainly in the deeper portion of the lesion.

　Our case and previously reported cases of colonic carcinoma associated with tuberculous colitis shared common macroscopic and histologic characteristics, indicating that the association of colonic carcinoma with tuberculous colitis is a specific clinico-pathological condition. The possible etiological relationship of the two diseases is briefly discussed.