マッシュルーム様の形態を呈した直腸カルチノイドの1例

Pedunculated Carcinoid in the Rectum, Report of a Case

要旨　症例は60歳，男性．主訴は左頸部腫瘤．消化管の精査を目的に施行した大腸内視鏡検査で，下部直腸に大きさ20mmの黄色調を呈し表面に血管透見像を伴う有茎性病変と大きさ3mmの同性状の小隆起性病変を認め，多発する直腸カルチノイドと診断した．左頸部腫瘤は生検でschwannomaと診断された．進行直腸癌に準じた根治手術の適応と判断し，リンパ節郭清を含めた手術の必要性を十分に説明したが，患者および家族の希望により内視鏡的切除術を施行した．病理組織学的には2病変ともカルチノイド腫瘍であり，いずれも深達度smで脈管侵襲を認めなかった．有茎性を呈した直腸カルチノイドは比較的まれであり画像所見を中心に報告する．

　The patient was a 60-year-old man. He noticed a lump developing on the left side of his neck and was admitted to our hospital. Colonoscopy revealed a yellowish, pedunculated lesion, 20 mm in size, which showed enlarged capillaries on the surface and a protruded lesion, 3mm in size, with the same feature in the lower rectum. The lesions were diagnosed as multiple rectum carcinoids. The lump-in the left side of the patient's neck was suspected to be a metastasis of the carcinoid but it was finally diagnosed by biopsy as a schwannoma. Radical surgery equivalent to an operation for advanced rectum cancer was recommended and the necessity of the surgery was fully explained to the patient and his family. However, endoscopic resection was performed in accordance with the patient's and his family's choice. Histopathologically, the two lesions were both carcinoid tumors confined to the subumucosa and without vascular invasion. Pedunculated carcinoid is relatively rare. We report the case mainly by presenting the image findings.

　1) Department of Gastroenterology, Teine Keizinkai Hospital, Sapporo, Japan