上行結腸の同一病巣に癌と結核が合併した1例

Coexistence of Carcinoma and Active Tuberculosis in the Same Lesion of the Ascending Colon, Report of a Case

要旨　大腸結核を合併した大腸癌は比較的まれで，本邦報告例は38例のみである．上行結腸の同一病巣に癌と結核を合併し，結核菌も認められたまれな症例を経験したので報告した．患者は48歳の男性で，主訴は右上腹部痛である．胸部X線所見で右上肺野に陳旧性肺結核の所見を認めた．注腸X線および経口大腸X線所見で，上行結腸にapple-core様の所見を認め，癌と診断したが，内視鏡・生検所見では確診が得られなかった．手術標本では，肉眼的に大きさ6.0×5.5cmのBorrmann2型癌で，腫瘍の口側および肛門側の結腸粘膜には結核の所見は認められなかった．組織学的には同一病巣内に中分化型の腺癌と結核性の肉芽腫が混在して認められ，また抗酸菌染色にて多数の結核菌を認めた．

　A 48 year-old man patient visited our hospital with a complaint of right upper abdominal pain. Radiographic examination disclosed “apple core” appearance in the ascending colon and the flnding was radiographically consistent with carcinoma of the colon. Endoscopic biopsy of the lesion failed to confirm the diagnosis. Chest radiography detected some old tuberculous changes in the right upper field. Macroscopic findings of the surgical specimen were that it was 6.0×5.5cm in size, and that it was categorized as a Borrmann 2 type of carcinoma.

　No tuberculous changes were found macroscopically. Histological examination showed that a poorly differentiated carcinoma had invaded almost as far as the muscular layer, and some scattered foci had reached the subserosal layer. Moreover, epithelioid granulomatous changes with necrosis extended from the submucosa to the serosa. TB staining revealed numerous tuberculous bacilli in the same lesion. Coexistence of tuberculosis and carcinoma in the colon is rare and only 38 cases have been reported in Japanese medical literature. Our case is also rare in that it involved coexistence of these two diseases in the same lesion, and in that bacteriological confirmation of tuberculosis was able to be made.