興味あるⅡc＋Ⅰs型の形態を呈した大腸sm癌の1例

A Rare Case of Depressed Type Submucosal Invading Colon Cancer, Report of a Case

要旨　患者は44歳，女性．便潜血反応陽性にて来院．大腸内視鏡検査で，S状結腸に，面状不整な陥凹局面を有し，その辺縁にⅠs様の隆起部を伴う病変を認めた．空気変形陽性で，隆起部分に内視鏡的な硬さは認めなかった．Ⅱc＋Ⅰs型sm癌と診断し，開腹手術を施行した．病変は17×11mmで，高分化腺癌，深達度sm1a，ly0，v0，n1,2(－)であった．病理組織学的には，高異型度癌としての形質を獲得した腫瘍細胞が，陥凹性病変として発育し本病変のごとき形態を呈するに至ったと推測された．

　Case 44-year-old female. Colonoscopic examination was carried out, because the result of the fecal occult blood test was positive. Depressed type lesion with protruded margin (type Ⅱc＋Ⅰs) was detected by colonoscopic examination. Endoscopic findings of air induced deformity and sclerous change were negative. The pit pattern was Ⅲs with amorphism in the depressed lesion. We diagnosed that this lesion was submucosal invading cancer. It was treated by laparotomy. The lesion was 17 mm in diameter. Pathological findings showed that it was a well differentiated adenocarcinoma, whose depth of invasion was sm_1a, and no vessel invasion on lympho node metastasis was detected.

　This is a rare and very important case in the development of depressed type colorectal cancer.