腸結核に合併したと考えられる大腸癌の1例

Carcinoma of the Colon Which is Thought to be Affected by Tuberculous Colitis, Report of a Case

要旨　患者は49歳女性，下腹部痛を主訴として来院した．注腸X線検査で上行結腸下部にapple-core様狭窄が存在し，更に上行結腸から下行結腸の腸管には輪状狭窄，腸管の短縮，Haustraの消失が認められ，また小隆起，微小潰瘍，潰瘍瘢痕が多発していた．内視鏡検査にても同様の所見が認められた．腸結核と大腸癌の合併と診断し，結腸右半切除術を施行した．切除標本では短縮変形した下行結腸に大きさ6.5×4.5cmの2型大腸癌を認めたが，潰瘍周囲の周堤は幅広く丈が低かった．病理組織学的に中分化腺癌で，深達度はsであった．腸管，リンパ節とも結核性肉芽腫は認められなかったが，腫瘍肛門側の腸管には数個のUl-ⅡやUl-Ⅲの潰瘍瘢痕や再生粘膜がみられた．

　A 49 year-old woman complaining of lower abdominal pain was admitted to our hospital for the detailed examination of the colon.

　Pictures of the barium enema study showed an apple-core narrowing in the ascending colon. And a circular stricture was found in the descending colon. The shape of cecum was transformed, and both the ascending and the transverse colon were shortened and accompanied by small polyps, small ulcers and ulcer scars. The haustration of the colon had disappeared between the ascending colon and the upper descending colon.

　Endoscopic examination revealed a tumor in the ascending colon and irregularly shaped nodular elevations and small ulcers at the anal side of the tumor. Their surface was reddish and bled easily. A circular stricture with small ulcers and small inflammatory polyps was observed in the descending colon.

　In the resected material, an irregular ulceration surrounded by a flat and wide elevated wall was measured 6.5×4.5cm in the ascending colon. The mucosa of the cecum and the ascending colon was atrophic. Multiple small polyps and ulcer scars were seen in the cecum and the ascending colon.

　The histological type of the colonic cancer was moderately differentiated adenocarcinoma. The cancer cells had partially infiltrated the serosa. Some ulcer scars (Ul-Ⅲ and Ul-Ⅱ) and regenerated mucosa were seen in the ascending colon, but no tuberculous granulomas were observed.