回盲部切除で治癒切除が得られた小腸腺腫内癌の1例

Carcinoma in Adenoma of the Small Bowel Curatively Resected by Ileocecal Resection, Report of a Case

要旨●患者は60歳代，男性．便潜血陽性にて大腸内視鏡検査を施行し，回腸末端部に亜全周性の30mm大無茎性病変を認め，性状は表面発赤調で小結節集簇性を呈していた．小腸カプセル内視鏡検査や注腸X線造影検査にて小腸Crohn病などの多発性腸管病変は認められなかったが，悪性所見を否定しきれず，診断的治療目的に回盲部切除術が行われた．病理組織学的診断では粘膜内にとどまる高度異型を呈する管状絨毛腺腫を認め．一部に癌を含んでおり，腺腫内癌の結果であった．治療後も再発なく経過している症例を経験したため報告する．

　A man in his 60s underwent colonoscopy for the investigation of a positive occult fecal blood test. A subcircumferential sessile lesion, 30mm in diameter, was found in the terminal ileum. Its surface was reddish, with aggregated nodules. Small bowel capsule endoscopy and barium enema examination found no evidence of multiple intestinal lesions in the small bowel such as Crohn's disease. As a malignant lesion could not be ruled out, ileocecal resection was performed for the purpose of diagnosis and treatment. Histopathological examination revealed the presence of a tubulovillous adenoma that appeared to be partially highly atypical. The final diagnosis was carcinoma in tubulovillous adenoma. The patient has had no recurrence at approximately 3 years after treatment.