大腸海綿状血管腫の1例

Cavernous Hemangioma of the Ascending Colon, Report of a Case

要旨　患者は42歳，男性．主訴は便秘．腹部単純X線像で上行結腸に一致して，大小不同の小円形の石灰化陰影を認めた．注腸X線像で上行結腸に比較的表面の平滑な隆起性病変を認め，内視鏡所見では亜有茎性病変で，腫瘍の表面は正常粘膜で覆われるが，青色調の透見部分が散在し，血液の貯溜が示唆された．単純CT像で腸管の輪郭内にIow density areaと石灰化巣を認め，造影CT像で一部に周囲の腸管壁と同等に不均一に造影される腫瘤陰影を認めた．血管造影では石灰化巣を包む濃染像を呈し，大腸血管腫と診断した．肉眼像は径53×33mm，亜有茎性の粘膜下腫瘍で，病理組織所見では粘膜下層，筋層，漿膜下層に，多数の大小不同の血管腔と内腔に赤血球，fibrinを含み，器質化や石灰沈着を認めた．血管壁の大部分は弾性線維から成り，平滑筋の発達は弱く，海綿状血管腫と診断した．

　A 42-year-old man with a complaint of constipation was refereed to our medical center. Plain abdominal x-ray examination showed multiple small phleboliths in the right upper abdomen. Barium enema revealed a protruding lesion with a smooth surface in the ascending colon. Endoscopic examination showed a protruding lesion covered with normal mucosa. There were some bluish areas scattered on its surface, which suggested pooling of blood inside. Plain abdominal CT scan showed a low density area and calcifications in the ascending colon. Enhanced CT scan revealed an irregularly enhanced mass lesion in the intestinal wall. Abdominal angiographic examination demonstrated increased vascularity around the multiple calcified lesions in the ascending colon. These findings led to a diagnosis of cavernous hemangioma. Right hemicolectomy was performed. Pathological diagnosis was cavernous hemangioma of 53 mm in size.