まれな大腸癌の臨床─びまん浸潤型を中心に

Diffuse Invasion Type Colorectal Cancer

要旨●まれな大腸癌として，びまん浸潤型大腸癌のうち，診断を行ううえで注意が必要な管腔狭小化を伴う5症例と粘膜内癌の範囲が狭い2症例を提示した．これら7例を発育浸潤様式の相違などから分類すると，lymphangiosis（LA）型，muconodular（MN）型，scirrhous（SC）型，inflammatory（IF）型，MN型＋LA型の混合型，perineural invasion（PN）型とendocrine cell carcinomaであった．内視鏡検査で管腔狭窄を認めた場合，肛門側に上皮性腫瘍性の周堤がなければ，腫瘍性か炎症性かを総合的に診断する必要があるが，注腸X線造影検査を行えば，狭窄部のX線所見から鑑別診断と，びまん浸潤型における発育浸潤様式を診断することが可能であった．

　We presented rare cases of colorectal cancer, including five cases of diffuse invasion-type colorectal cancer with luminal narrowing and two cases of diffuse invasion-type colorectal cancer with a small area of intramucosal carcinoma. When colonoscopy reveals stenosis, unless mound of epithelial neoplasm is present on the anal side, comprehensive diagnosis should be performed keeping diffuse invasion-type colorectal cancer and inflammatory disease with stenosis in mind. In particular, examination by contrast enema enables differential diagnosis from X-ray findings of the site of stenosis, and if diffuse invasive colorectal cancer is found, growth and invasion pattern can be diagnosed.