放射線腸炎に発生した大腸癌の1例

Colon Cancer Associated with Radiation Colitis, Report of a Case

要旨　患者は70歳の女性．1994年2月に腹痛にて近医を受診した．注腸X線検査にて，直腸・S状結腸に狭小化が認められ，精査目的にて紹介入院となった．ゾンデ小腸造影検査では回腸遠位部にも狭小化を認め，注腸X線検査にてS状結腸に腫瘍性病変が認められた．既往症として1967年に，子宮頸癌にて放射線治療が施行されており，放射線腸炎に合併した大腸癌を疑い，Miles' operationおよび回腸部分切除術が行われた．術中内視鏡検査にてS状結腸に1型の隆起性病変が認められた．病理組織診断は放射線腸炎に合併した大腸粘液癌であった．放射線誘発大腸癌と考えられる1例を経験したので報告した．

　A 70-year-old female presented with abdominal pain in February 1994. She had undergone barium enema examination at a local hospital, and a stricture was pointed out in the rectosigmoid colon. She was referred to our institution for further evaluation. Double-contrast small-bowel examination revealed strictures involving long segments of the distal ileum. Repeated barium enemas showed tumor in the sigmoid colon. Because she had a past history of radiation therapy for uterine cancer 27 years previously, radiation-associated colon cancer was suspected. She underwent Miles' operation and partial resection of the ileum. Intraoperative colonoscopy showed a polypoid lesion of type 1 in the sigmoid colon. Histopathologic examination of the resected specimen showed mucinous adenocarcinoma associated with radiation enterocolitis.