9歳女児に発生した結腸癌の1例と本邦報告例の検討

Colon Cancer of a Nine-Year-Old Girl and Review of the Case Reports in Japan

要旨　9歳7か月の女児が腹痛と嘔吐を訴えて来院し，イレウスと診断されたが閉塞機転は不明であった．イレウス解除の目的で緊急開腹手術を施行したところ横行結腸に癌が発見された．H₀P₀sn₁のStage Ⅲで，二期分割手術によりR3の郭清を行った．組織学的には中分化腺癌で化学療法を併用して術後2年の現在再発をみない．14歳以下の小児結腸癌は本症例を含めて29例が報告されており，それらの40％以上は粘液癌もしくは印環細胞癌である．予後を確認しえた25例中5年以上の生存を得たものは，わずか4例にすぎず，成人の結腸癌に比べて著しく予後不良である．

　A nine-year-and-seven-month-old girl consulted our surgical clinic complaining of abdominal pain, nausea, and vomiting. Her abdominal wall was markedly distended but without any sign of defence musculair. Abdominal x-ray picture revealed niveaux, which implied intestinal obstruction (Fig. 1).

　An emergency operation disclosed a cancer of 3 cm in diameter in the transverse colon (Fig. 2, 3). A transverse colectomy with lymphadenectomy was carried out. The pathological diagnosis was that of a moderately differentiated adenocarcinoma (Fig. 4).

　Twenty-nine cases of colon carcinoma of patients younger than 14-year-old have been reported in Japan, the youngest among which are two cases of nine-year-old patients (Table 2). Mucinous and signet-ring cell carcinomas are much more common in children than in adults (Table 3). Only four patients have survived more than five years among the 25 cases followed up. Intestinal polyposis was found in four cases (one benign, three malignant).