潰瘍性大腸炎の長期経過中に発見された小さなIIc＋IIa様進行大腸癌の1例

A Small IIa＋IIc-like Advanced Carcinoma Associated with Ulcerative Colitis Detected During the Long Term Follow-up, Report of a Case

要旨　63歳，女性．潰瘍性大腸炎発症後2年で全大腸型へと進展し，SalazopyrinとPredonine内服と水溶性Predonine注腸療法を行い，緩解増悪を繰り返してきた．右側結腸の活動性は低下してきたが，S状結腸は伸展不良となり鉛管状を呈し炎症性ポリープを認めるようになった．発症15年目，S状結腸にIIc＋IIa様病変を認め生検で癌が検出され，左側結腸切除が施行された．切除大腸の組織学的検索で，IIc＋IIa様病変は低分化腺癌主体の深達度mpの進行癌であり，他の部位には癌・dysplasiaは認めなかった．手術2年前の注腸X線写真を再検討すると同部位にごく軽度の伸展不良を認め，この癌の初期像が描出されているものと考えられた．

　A 63-year-old woman with ulcerative colitis throughout the whole colon has been followed up for 15 years. In spite of treatment by Salazopyrin and Predonine, remission and recrudescence have been repeated. Although the activity of the inflammation gradually decreased in the right-sided colon, the sigmoid colon became stenotic with lead pipe appearance and inflammatory polyps. In the sigmoid colon, a IIa＋IIc-like lesion was detected and was diagnosed by biopsy as a carcinoma. Left hemi-colectomy was carried out. Histologically, the carcinoma was mainly composed of poorly differentiated adenocarcinoma invading the muscularis propria. By histological examination with serial step sections, no other carcinoma or dysplasia was detected. Retrospectively, double contrast barium enema revealed slight and focal less extensive rigidity, and this finding was considered to be an early stage of the carcinoma.