進行癌を病変内部に随伴した大腸結節集簇様病変の1例

Nodule-aggregating Lesion with Advanced Cancer of the Colon, Report of a Case

要旨　患者は73歳，女性．血便を主訴に来院．大腸内視鏡検査で上行結腸に管腔のほぼ全周を占める丈の低い隆起病変を認めた．隆起表面は顆粒～結節状を呈し，隆起中央には，周堤を伴う潰瘍を認めた．X線所見では，潰瘍周囲は台形状変形を呈しており，結節集簇様病変内の進行癌の存在が疑われた．丈の低い隆起および潰瘍辺縁からの生検病理組織診断はそれぞれ腺腫，中分化腺癌であった．以上から，進行癌を伴った，いわゆる結節集簇様病変と診断し右半結腸切除術を施行．切除標本では病変は9×5cmで，中心に陥凹を有する丈の低い表面結節状の隆起病変から成り，病理組織所見は丈の低い隆起は腺管絨毛腺腫で，病変中心部の潰瘍部は中分化腺癌で深達度ssの2'型進行癌であった．このような症例は比較的まれであり報告する．

　A 73-year-old woman was admitted to our hospital with a chief complaint of bloody stool. Barium enema showed an almost encircling elevated lesion with an aggregated granular surface, which accompanied an advanced cancer in the ascending colon. Pneumatic expansion revealed intact distensibility of the ascending colon. Endoscopic examination showed a minimally elevated Lesion whose surface color was almost identical to that of surrounding mucosa. The border of the tumor was clearly demonstrated by dye-spraying method. The biopsy specimens of the elevated lesion and ulceration showed tubulovillous adenoma and moderatery differentiated adenocarcinoma respectively. Right sided hemicolectomy was performed. Macroscopically, the lesion was 9 X 5 cm in size with and accompanied an ulceration in the center. Histological examination showed that the tumor consisted largely of tubulovillous adenoma, and the ulceration in the center was replaced by moderately differentiated adenocarcinoma with subserosal invasion.