大腸結核瘢痕部に併存した大腸癌の1例

Colon Cancer Present in the Scar of Colon Tuberculosis, Report of a Case

要旨　患者は63歳女性．貧血を主訴に来院した．結核の既往歴，家族歴はなかった．注腸X線検査で，盲腸の消失，上行結腸の長軸方向の著明な短縮，炎症性ポリープと偽憩室の所見から，結核性萎縮瘢痕病変と考えられた領域内に大きさ約5.0cmの表面粗糙で，背の低いⅡa様隆起を認めた．隆起は鉗子生検で腺癌であった．切除標本の全割切片による組織学的検索の結果，結核の所見は見出せなかったが，腸管上皮の萎縮と粘膜下層の陳旧性線維化があり，Ⅱa様隆起は腺腫を伴わない高分化腺癌であった．すなわち，本例は大腸結核の疑診例であったが，この瘢痕萎縮病巣内に大腸癌を併存した極めてまれな病態であった．文献的に両疾患の特徴と関連性について考察した．

　A 63 year-old woman visited the hospital with a complaint of anemia. Neither she nor her family had tuberculosis in their medical histories. Barium enema study revealed marked shortening of the ascending colon in a longitudinal direction, accompanied by disappearance of the caecum, formation of a pseudodiverticulum, and the presence of inflammatory polyps. These findings suggested a tuberculous atrophic scar lesion. Observed in this region of the scar lesion was a low Ila-like elevation of coarse surface measuring about 5.0 cm in size. A forceps biopsy of the elevation disclosed adenocarcinoma. A histological examination of the resected specimen revealed no evidence of tuberculosis but an area of atrophy of the tubular epithelium and old fibrosis of the submucosa. The Ila-like elevation was well differentiated adenocarcinoma without adenomatous change. This patient, though suspected of having colon tuberculosis, presented an extremely rare pathological condition viz. a colon cancer in an atrophic scar region, Referring to current literature on the subject, discussion was held on the characteristics of, and the relation between the two diseases.