Ⅱa＋Ⅱc型早期大腸癌の1例

Ⅱa＋Ⅱc Type Minute Early Carcinoma of the Transverse Colon, Report of a Case

要旨　患者は70歳，男性．右下腹部不快感を主訴として来院，注腸造影検査で回盲部の異常を指摘され内視鏡検査を施行した．指摘の個所は特に異常をみなかったが横行結腸中部腹側に中心やや陥凹のみられる小扁平隆起性病変を発見，生検ではGroup 5の診断であった．切除標本では中心に3×3mmの陥凹を有する最大径7×5mmの扁平な隆起で，Ⅱa＋Ⅱc様所見を呈していた．また，手術時所属リンパ節ならびに肝転移は認められなかった．組織学的には高分化腺癌で粘膜下浸潤部では低分化腺癌となっていた．

　A 70-year-old male patient was admitted to the Department of Internal Medicine, Kosei General Hospital, Tokyo, with a chief complaint of the discomfort of the right lower quadrant of the abdomen. The initial barium-enema examination revealed an abnormal deformity of the ileocecal region, and the subsequent colonoscopy showed normal ileocecal region.

　A small flat elevation of the mucosa with central depression was detected at the ventral side of the midtransverse colon and biopsy was positive for cancer.

　On the operated specimen the flat elevation of the mucosa measured 7×5 mm in the greatest diameter with the central depression of 3×3 mm. Macroscopically the diagnosis of Ⅱa＋Ⅱc type early cancer was made. There was no lymh node nor liver metastases.

　On the histologic examination the lesion was diagnosed as well differentiated adenocarcinoma with extensive sumucosal involvement (sm-cancer).