大腸癌の口側に合併する潰瘍性病変

Colonic Ulcer in the Oral Sites of Carcinoma

　大腸癌の口側腸管に潰瘍をともなう腸炎の合併することはしばしば経験される．われわれはこのような大腸癌と潰瘍の合併した症例7例の，いずれも手術切除例をもとに臨床および組織学的に検討し，そのetiologyなどについて若干の文献的考察を加え報告する．

　We have presented seven patients with carcinomas of the colon, associated with ulcerative lesions in oral sites apart from the original neoplastic lesions, Clinical and morphologic investigation of each case was performed, especially of the ulcer lesions. Patients were mostly in older age group with male predominance. Diarrhea, bloody stool or abdominal distension developed frequently, and patients complained various other symptoms. Leukocytosis in mild to moderate degree was an usual laboratory finding. All the paients had no past history of ulcerative colitis or other diseases of the bowels.

　Gross examination of the ulcerative areas showed no evidence of continuity to the cancer lesions located more distally . The ulcers were characterized by linear appearance along the longitudinal line of the colon and were clearly well demarcated, though prominently irregular in size and shape, associated with edematous, congested, sometimes hemorrhagic regions in the surrouding mucosa. Histologically, the ulcerative areas were characterized by degenerative and necrotic changes of the mucosal membrane, associated with edema, congestion and/or hemorrhage in the submucosal tissue.

　These morphologic characteristics might be related to the ischemia of the intestinal wall, secondary to the increased pressure in the lumen of the bowel, which in turn was caused by the stenotic area at the distal portion. The high pressure in the lumen might result in the distension of the bowel wall and could reduce blood flow in the mucosal and submucosal tissue following ischemic change of the tissue. Histologic findings in two of seven cases were similar to those of granulomatous colitis and classical ulcerative colitis, respetively, though it was difficult to differentiate them from those of a prolonged process of ischemic colitis mentioned above.

　The incidence of the ulcerative lesion associated with carcinoma of the colon in our surgically treated cases of cancer of the colon without ulcer was 3.1％.