転移性大腸癌の形態診断―X線像の解析を中心に

Morphological Diagnosis of Metastatic Colon Carcinoma : Analysis of Radiological Findings

要旨　肉眼的・組織学的に大腸への転移が証明された105例を対象に，その注腸X線像を中心として転移性大腸癌の形態の解析を行った．X線像の形態は収束型，圧排型とびまん型の3型に，狭窄の程度から片側，両側と閉塞変形の3型に分けることができた．腺癌（胃癌，膵癌と胆囊癌）105病変中93病変は収束型を示し，特徴的所見と考えられた．肉腫5例はすべて圧排型を示した．子宮癌と卵巣癌のX線所見は，骨盤腔内に限局していたものが多く，収束型と圧排型を示し，乳癌は7病変中4病変がびまん型を示した．狭窄の程度は両側変形を示すものが59病変（56％）と最も多かった．びまん浸潤型の原発性大腸癌，Crohn病やその他の疾患との鑑別点についても述べた．

　One hundred and five cases with metastatic colon carcinoma diagnosed macro- as well as micro-scopically were analysed regarding cancer morphology on barium enema radiography. Morphologically three types were identified, i.e., tethered folds type, extrinsic mass type, and diffuse type. The degree of stenosis was classified into three types as well, i.e., one-side type, both-side type, and obstructive deformity type.

　Out of 105 lesions with adenocarcinoma originating from the stomach, pancreas, or gallbladder, 93 lesions were fell into the tethered type, which was considered characteristic to this type of metastatic cancer. All 5 cases with sarcoma showed extrinsic mass type. The cases with uterine or ovarian carcinoma, most of which were radiologically confined to the pelvic space, showed tethered folds type or extrinsic mass type. Four out of 7 cases with breast cancer presented with diffuse type. Most of stenotic lesions, 59 lesions (56%) fell into both-side deformity group.

　Comments were also made with respect to differentiating between metastatic colon carcinoma, diffuse invasive primary colon carcinoma, Crohn's disease and other pertinent diseases.