villous tumor様形態を呈した大腸炎症性腫瘤の1例

Giant Inflammatory Tumor Resembling Villous One in Shape, Report of a Case

要旨　患者は53歳，男性．主訴は非粘血性下痢．臨床検査成績では白血球増多を認め，便潜血反応陽性であった．X線像・内視鏡像および標本の肉眼像で上行結腸肝曲部に7×5×2cmの大きな腫瘤を認め，その表面は比較的粒子の揃った小円形顆粒より成り，絨毛腫瘍に酷似した像を呈していた．また，腫瘤より肛門側の横行結腸から下行結腸にかけて扁平な小隆起を散在性に認めた．病理組織学的に腫瘤は炎症性腫瘤であり，粘膜筋板の乱れ，粘膜下層の線維化と血管拡張，陰窩膿瘍，Paneth cell metaplasiaが認められ，小隆起病変でも同様の変化がみられた．肉眼的に明らかな異常を認めない粘膜にも炎症性変化がみられ，潰瘍性大腸炎との関連が示唆された．

　A 53-year-old man was admitted to the hospital because of non-bloody diarrhea in the past six months. Stool was positive for occult blood with neutrophilia. X-ray and endoscopic examinations revealed a giant tumor in the hepatic flexure of the colon. The tumor, resembling a villous one in shape, was covered with small granules of the same size. Small flat elevations were scattered from the transverse colon to the descending colon. Thus, right hemicolectomy was carried out. The tumor, 7×5×2 cm in size, was an inflammatory one. The pathological findings were as follows ; disordered muscularis mucosae, dilated vessels and fibrosis in the submucosa, crypt abscess and Paneth cell metaplasia. The same findings were also seen in the small flat elevations. Even in the mucosa seemingly normal macroscopically, the inflammation was found microscopically. It is speculated based on these findings that underlying is ulcerative colitis in this case.