陥凹型早期直腸癌の1例

Type IIc Early Carcinoma of the Rectum, Report of a Case

要旨　患者は75歳，女性．1986年8月末より便柱の細小化に気づいていたが，9月中旬患者自身が指を挿入して直腸内に腫瘤を触知し，同時に指先に血液付着を認めたため，9月24日他院を受診した．大腸内視鏡検査で肛門縁より約9cmの部位に出血を伴った浅い潰瘍性病変を指摘され，生検にて癌と診断された．新鮮切除標本では，不整形を呈する大きさ2.2×1.5cmの浅い潰瘍性病変があり，病理組織学的検索では，深達度smの高分化腺癌でリンパ節転移は陰性であった．また一部に粘液癌と腺扁平上皮癌の組織像が認められたが，腺腫成分は確認されなかった．

　A 75-year-old woman was admitted with a complaint of small amount of rectal bleeding on September 24, 1986. Colonoscopy revealed a shallow depression at 9 cm from the anal verge (Fig. 1). Biopsy specimen was positive for adenocarcinoma (Fig. 2), while barium enema examination failed to demonstrate the lesion.

　Low anterior resection was perfomed with lymph node dissection on October 21. The operative specimen showed a superficial depression, measuring 2.2×1.5 cm in size (Figs. 3a, b and c).

　This type Ⅱc lesion was histologically diagnosed as well differentiated adenocarcinoma with submucosal invasion (Figs. 4 band 5a), Moreover, the histology of mucinous carcinoma as well as adenosquamous carcinoma was recognized in the submucosal layer (Figs. 5b and c). However, adenomatous glands were not observed and lymph nodes were free from metastasis microscopically.