短期間に急速にX線所見が変化したびまん浸潤型大腸癌の1例

Rapid Progression of Diffuse Infiltrating Carcinoma of the Colon Observed Radiographically, Report of a Case

要旨　X線所見上，23日間に急速な変化を来した横行結腸のびまん浸潤型大腸癌の1例を経験した．患者は34歳，男性．主訴は右下腹部痛．初回注腸X線検査は，潰瘍浸潤型大腸癌とみなすべき所見であったが，23日後には，病変口側の軽度の壁硬化所見が高度の伸展不良となり，明らかなびまん浸潤型に変化した．生検の組織学的所見は中分化腺癌で，右半結腸切除術が施行された．病理組織学的所見はリンパ管侵襲の強い中分化腺癌であった．術後112日でリンパ節への転移再発を来した．びまん浸潤型大腸癌の発育・進展様式を考えるうえで示唆に富む症例と考えられた．

　A 34-year-old male with the chief complaint of right lower abdominal pain was referred to the Cancer Instilute Hospital. The first barium enema examination done in aprevious institution revealed a narrowed segment with distal ulceration in the transverse colon near the right flexure, and the diagnosis of a carcinoma, ulcerated infiltrating type, had apparently been made. However, in the second barium enema examination done in our institution 23 days later the narrowed segment had progressed to the ascending colon just beyond the right flexure, showing the appearance of diffuse infiltrating carcinoma. At the same time, the narrowing had become more pronounced. In the resected specimen, the lesion, measuring 120×70 mm, consisted of edematous mucosa with several polypoid growths, but it had ulceration (22×20 mm) in its distal side. The histologic examination disclosed moderately differentiated adenocarcinoma involving the entire thickness of the colonic wall with marked lymphatic permeation in the edematous submucosa, and with the extensive lymph node metastasis.