大腸結核症の病変内に併存した横行結腸癌の1例

Carcinoma of the Transverse Colon Associated with Colonic Tuberculosis, Report of a Case

要旨　患者は59歳の女性．1980年8月に動悸，息切れを主訴として来院．大腸X線および内視鏡検査において，右側結腸に主座を置く広範な治癒結核所見があり，その病変内の横行結腸口側に，明らかな周堤隆起を伴わない限局潰瘍型の癌が認められた．1980年12月に，結腸右半切除が施行されたが，術後の組織学的検索で結核病変に併存した癌は高分化腺癌にもかかわらず，著明な線維形成がみられた．粘液変性は著明ではなかった．

　A 59 year-old woman whose main complaint was dyspnea and palpitations when exercising was admitted to our hospital. Radiological examination demonstrated remarkable shortening with multiple pseudo-diverticles caused by multiple ulcer scars of the right-side colon, and a long narrowing leslon in the proximal transverse colon. The surface of the mucosa involved was revealed as a scarred area with discoloration in the entire lesion. These observations led to a diagnosis of typical healed colonic tuberculosis.

　Near the hepatic flexure, a gigantic ulcerative lesion without randwall and converging folds was recognized. This ulcerative lesion apparently differed from that of typical colonic cancer radiographically and endoscopically. The biopsy specimen of this lesion revealed well differentiated adenocarcinoma. The surgical material showed localized ulcerative colonic cancer, 5 cm in size.

　Histologically, cancer cells had infiltrated the serosa of the colon. A histological diagnosis of well differentiated adenocarcinoma, ly₁, v₂, stage Ⅲ was made. It's metastasis to the lymphatic nodule could not be examined. The type of colonic cancer in this case was neither the so-called constricting type such as scirrhous nor mucus-producing carcinoma, but this cancer was accompanied by a certain amount of fibrosis, so it can be said to differ from that of common colonic cancer, Borrmann type 2.