内視鏡検査時に粘液の排出を認めた虫垂粘液嚢胞腺癌の1例

Colonic Endoscopy of Mucinous Cystadenocarcinoma of the Appendix Shown Discharging Mucin, Report of a Case

要旨　患者は83歳，男性．1992年10月20日ごろから繰り返す回盲部痛で入院．大腸X線検査で盲腸下極に粘膜下腫瘍様隆起を認めた．大腸内視鏡検査では虫垂開口部周辺に正常粘膜に覆われた弾性硬の隆起が存在した．また虫垂開口部は開大し，同部からどろどろした粘液の排出を認めた．以上から虫垂の粘液囊胞腺癌または粘液囊胞腺腫と診断し手術を施行した．術中，腫瘍の回腸末端への浸潤を疑い，癌と判断し右結腸切除術を行った．腫瘍は6.0×5.0×2.6cmで病理組織学的には粘液囊胞腺癌であった．大腸内視鏡検査で粘液の排出を確認できた症例の報告はなく，貴重な症例と考え報告した．

　An 83-year-old man experienced ileocecal pain in the two months before his admission to the Fukuoka Seijinbyo Center in December, 1992. Barium enema showed a submucosal tumor-like lesion in the lower position of the cecum. Colonoscopic examination showed an elevated lesion covering the normal mucosa around the opening of the vermiform appendix. It had dilated and was discharging mucin. Based on the x-ray examination and endoscopic findings, the patient was diagnosed as having mucinous cystadenocarcinoma or mucinous cystadenoma and underwent an operation. Because the lesion adhered to the end of the ileum during the operation, we diagnosed it as mucinous cystadenocarcinoma and performed a right hemicolectomy. Histological examination of the resected specimen disclosed mucinous cystadenocarcinoma. The case reports indicate that the discharge of mucin in mucinous cystadenocarcinoma has never been observed before.