上行結腸に炎症性ポリポーシスと進行癌の併存した1例

Advanced Cancer with Inflammatory Polyposis in the Ascending Colon, Report of a Case

要旨　45歳，女性．右下腹部鈍痛を主訴として来院した．注腸X線検査で上行結腸に炎症性ポリープが多発し，この病巣に重なって腸管長軸に優位な大きな潰瘍がみられた．内視鏡でこの潰瘍を癌と断定できなかったが，生検陽性であった，切除標本で潰瘍辺縁は肛門側ではびらん状，凹凸不整で一部は周堤様に隆起しているが，口側には周堤と言えるものはなく，通常みられる大腸進行癌の肉眼形態とかなり異なっていた．炎症性ポリープはその成因を確定しえないが，臨床検査および病理組織学的所見を総合して陳旧性腸結核とした．癌は漿膜を越える進行癌であった．結核と合併する大腸進行癌の肉眼形態は通常と異なることが指摘されているが，本例もその範疇に入る．

　A case is reported of a 45 year-old female who had both advanced cancer and inflammatory polyposis in the ascending colon. The patient was admitted to our hospital complaining of dull pain, for three weeks, in the right lower abdominal quadrant.

　Barium enema study revealed shortening of the ascending colon and deformity of the cecum although the terminal ileum was connected with them in normal fashion. In the ascending colon, the lateral contour had normal expansion except for two abnormal indentations, and the median side was irregular and stiffened. The enface view showed a longitudinal amorphous area surrounded by a translucent area, which indicated advanced cancer. Many small round and rod-shaped translucencies nearby suggested inflammatory polyps. Endoscopy also showed many inflammatory polyps and a large crater surrounded by an irregularly and slightly protruded margin. Biopsy showed adenocarcinoma, and histopathological examination of the resected specimen also revealed adenocarcinoma and inflammatory polyps of unknown origin.

　It was speculated that inflammatory polyposis with marked and dense fibrosis in the submucosa was most probably the burned-out remnant of intestinal tuberculosis, even though there were no granuloma with or without central necrosis in the resected colon and lymph nodes (Stomach and Intestine, vol. 13, no. 9, 1978). The characteristics of this case were longitudinally extended cancer lesion without prominent marginal elevation. This is not usually seen in advanced cancers of the colon.