腸結核病巣内に合併したmp癌の1例

Carcinoma in the Ascending Colon Associated with Colonic Tuberculosis, Report of a Case

要旨　患者は56歳，女性．17歳時に肺結核の診断で治療歴あり．便潜血反応陽性のため精密検査目的に受診した．胸部X線検査では陳旧性肺結核の所見を示した．大腸内視鏡検査で，右側結腸の萎縮瘢痕帯および炎症性ポリープと盲腸の潰瘍性病変を認めた．そのほかに中等度異型腺腫を認めた．右半結腸切除術が施行された。上行結腸は短縮し，盲腸に23×22mmの潰瘍性病変を認めた．盲腸部の病変は，病理組織学的に中分化腺癌から成り，癌の側方および深部の先進部に非乾酪性の結核結節を認め，結核結節内に癌細胞が混在した．腸結核病巣内に合併した上行結腸mp癌であった．

　A 56-year-old female visited the hospital because fecal occult blood test was found to be positive in the first screening for colorectal cancer. At the age of 17, medical treatment had been carried out for pulmonary tuberculosis. Barium enema examination demonstrated remarkable shortening of the ascending colon with multiple ulcer scars and multiple inflammatory polyps, and deformity of the cecum. Colonoscopic examination revealed multiple polyps and multiple ulcer scars in the transverse and ascending colon. In addition, an ulcerated lesion with surrounding elevation of the ileocecal region was found. Biopsy taken from the ulcerated lesion disclosed adenocarcinoma.

　Histological examination of the resected specimen revealed moderately differentiated adenocarcinoma with marginal hyperplastic mucosa, marked submucosal fibrosis and non-caseating granuloma with Langhans-type giant cell in the deep portion of the lesion. These findings were characteristic of carcinoma associated with tuberculosis. Some granulomas included carcinoma cells which were partly degenerative.