潰瘍性大腸炎に合併した多発大腸癌の1例

Multicentric Colonic Carcinoma Accompanied with Ulcerative Colitis, Report of a Case

要旨　14歳で全大腸炎型の潰瘍性大腸炎を発症し，16年の経過中に直腸，横行結腸，上行結腸の多発大腸癌が発生した症例について，過去3回の注腸造影検査（1974年，1979年，1984年）による，その発育過程の解析を行った．切除標本の病理組織学的検索では，癌部周辺に広範な異型腺管がみられ，更に潰瘍性大腸炎の再生腺管と異型腺管の境界部を認め潰瘍性大腸炎を母地に発生した多発大腸癌と診断した．潰瘍性大腸炎患者のsurveillanceと癌化の問題点を考察した．

　We report a case of a 31 year-old man who devel-oped carcinoma of the colon during a 16-year period of observation of entire ulcerative colitis. Though this patient had been treated with salazopyrine and prednisolone since the onset of ulcerative colitis in 1968, remission alternated with relapse. Colography performed in 1974 revealed atrophic type regression. In 1979, narrowing from the rectum to the sigmoid colon and flat elevation in the mid-transverse colon were detected. In 1984, a cauliflower-like tumor image was detected in the rectum. Increased elevation in the transverse colon and granular elevation in the cecum were also observed. Total colonoscopy was performed, and a diagnosis of well differentiated adenocarcinoma was made by biopsy of three areas which appeared adenomal on x-rays. Since the patient refused surgery at first, total colectomy and ileostomy were carried out after one year in November, 1985. Operative specimen revealed one tumor each in the ileo-cecal region, transverse colon and sigmoid colon. Microscopic examination of all three lesions disclosed a well differentiated adenocarcinoma infiltrating the serosa. Furthermore, these invasive carcinomas were surrounded by extensive patchy lesions of various degrees of epithelial dysplasia suggestive of precancerous change and intramucosal carcinoma.