瘻孔形成と組織学的に癌の合併が認められた大腸結核の1例

Colonic Cancer Complicating Tuberculosis of the Colon, Report of a Case

要旨　患者は61歳，女性．腹部腫瘤からの膿汁分泌を主訴として，1985年7月入院．現症で胆石手術創の下方に腫瘤を触知した．創の下端が離開し，その部より膿汁の分泌が認められた．膿汁中に結核菌が培養で証明された．注腸X線所見は右側結腸の治癒結核の像であった．腹部CTで腹壁膿瘍の所見を認め，瘻孔造影で，盲腸・皮膚瘻が確認された．抗結核療法を施行し，排膿が止まったため，1986年1月，外科的に瘻孔摘除，右半結腸切除術が施行された．術後の組織学的検索により盲腸癌の合併が確認され，周囲粘膜には異型腺管がびまん性に拡がっていた．

　A 61 year-old woman was admitted with pus discharge from an abdominal tumor on her right side. Barium enema examination showed tuberculosis of the ascending colon in the healing stage.

　Abdominal CT demonstrated an abdominal wall abscess. Futhermore, the fisterography revealed this fistula was formed between the abdominal wall and the cecum. Mycobacterium tuberculosis was isolated by culture of pus from the fistula. After treatment with antituberculotic drugs for four months, pus discharge from the fistula of the abdominal abscess disappeared.

　Right-hemicolectomy was performed. Multiple small polypoid lesions were scattered on the tubercular scarred mucosa of the resected specimen.

　Histologically, cancer cells were found in multiple small polypoid lesions and had infiltrated sporadically all the layers of the colon. Some tuberculoid granulomas were observed in and near the cancerous tissue. The histological type of colonic cancer was well diffentiated adenocarcinoma with the appearance of mucus-producing carcinoma.