サーベイランスを行っていたがStage IVでみつかった潰瘍性大腸炎合併虫垂癌の1例

A Case of Appendiceal Cancer Associated with Ulcerative Colitis Diagnosed at Stage IV Despite Surveillance Colonoscopy

要旨●毎年サーベイランス大腸内視鏡検査を行っていたが腹膜播種を伴うStage IVでみつかったUC合併虫垂癌の1例を報告する．患者は70歳，女性．29年前に潰瘍性大腸炎（UC）を発症したが，薬物療法にてコントロールされていたが，腹痛，腹満を訴えて入院となった．大腸内視鏡検査（CS）では虫垂開口部は観察できず，Bauhin弁がやや発赤してedematousであったため，生検したところ腺癌（tub2>muc>sig）が検出された．注腸X線造影検査では盲腸壁の変形がみられ，CTでは回盲部に腫瘍が疑われたため，虫垂癌を疑った．腹腔鏡補助下回盲部切除術を施行したが，腹膜播種がみられた．病理結果は，虫垂原発癌が回腸，盲腸へ浸潤していた．V，5型，43×25mm，sig with mucus production，T4b，NX，M1b，G3，Stage IVB（TNM分類）であった．術後8か月で癌のため永眠された．

　We report a case of appendiceal cancer associated with stage IV ulcerative colitis（UC）with peritoneal dissemination despite annual colonoscopy surveillance. A 70-year-old female patient developed UC 29 years ago, which had been treated with drug therapy. She was admitted to the hospital because of abdominal pain and fullness. The appendix opening could not be observed during colonoscopy, and the Bauhin valve was slightly red and edematous. Therefore, biopsy was performed to detect adenocarcinoma（tub2>muc>sig）. Barium enema X-ray revealed cecal wall deformation. Computed tomography scan revealed a tumor in the ileocecal region. Appendiceal cancer was suspected. Laparoscopically-assisted ileocecal resection was performed, detecting peritoneal dissemination. Pathological examination revealed primary appendiceal cancer in the ileum and cecum. The tumor was V, type 5, 43×25mm, sig with mucus production, T4b, NX, M1b, G3, and stage IVB（TNM classification）. She died from cancer 8 months after surgery.