4型大腸癌と鑑別を要する疾患―転移性大腸癌との鑑別

Differentiation between Diffusely Infiltrating Carcinoma of the Colon and Metastatic Colon Carcinoma

要旨　最近5年間に経験した4型大腸癌5例と転移性大腸癌12例を対象に鑑別所見につき検討した．4型大腸癌は全例が全周性狭窄のため内視鏡の深部挿入は困難であったが，狭窄部には結節状変化または易出血性粘膜所見を認めた．転移性大腸癌では内視鏡を施行した9例中6例は全周性狭窄で深部への挿入が困難であったが，狭窄部はいずれも粘膜の明らかな結節状変化はなく平滑であった．注腸X線所見では転移性大腸癌において，わずかな縦じわ所見が重要であった．4型大腸癌と転移性大腸癌の鑑別が困難なことがあるが，注腸X線所見と内視鏡所見とを合わせれば両者の鑑別診断は可能と考えられた．

　Through five cases with diffusely infiltrating carcinoma of the colon and twelve cases with metastatic colon carcinoma during the last 5 years, the points of differentiation were examined. Each of the five diffusely infiltrating carcinomas of the colon had a circular stenosis, on account of which deep insertion of an endoscope was difficult. Four out of five cases showed nodular and friable mucosa in the stenosed part. On the other hand, in the group of metastatic colon carcinoma cases, the insertion of the endoscope to sufficient depths was difficult in six cases with a circular stenosis among nine cases for which endoscopy was conducted. However, in those cases there were no incidences of nodular and friable mucosa. On barium enema radiography, nine out of twelve metastatic colon carcinomas showed some thin longitudinal folds in the mesenteric side, but these folds were not present in diffusely infiltrating carcinomas. Those characteristics on endoscopy and barium enema radiography were important for differentiating between diffusely infiltrating carcinoma of the colon and metastatic colon carcinoma.