大腸表面型潰瘍(IIa + IIc)から進行癌への推移が注腸X線にて遡及的に検討できた1例 A Case Report of Superficial Colon Neoplasm Growing to Advance Cancer Retrospectively Evaluated by Roentgenelogic Findings

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症例は57歳,男性.23カ月前,S状結腸のIp型腺腫を内視鏡的に切除されている.経過観察中の注腸X線検査にて,横行結腸脾弯曲側にapple core signを指摘され,2型進行癌の診断で左半結腸切除術が施行された.切除標本では,ssまで浸潤した中分化腺癌であった.内視鏡的ポリペクトミーを行った23カ月前の注腸X線と比較したところ,ほぼ同一の部位に19×16mmのIIa+IIc型の表面型の腫瘍陰影が描出されていた.2回の注腸X線像の遡及的検討から,本症例は陥凹を伴う表面型腫瘍が2型進行癌へ進展発育したもので,そのdoublingtimeは7.6カ月と考えられた.大腸表面型腫瘍は,大腸癌への重要な経路で,隆起型腫瘍とは異なった発育進展様式をとるとされるが,本症例のようにその形態推移が遡及的に追跡できた報告はまだ稀である.このような症例を集積することは大腸癌の自然史の解明の一助となると思われる.

A 57-year-old male who had undergone polypectomy for a type Ip adenoma in the sigmoid colon 23 months before was admitted to our hospital for fecal occult blood and abdominal distension. Barium enema revealed an apple core lesion in the transverse colon. The diagnosis was a type 2 cancer and left hemicolectomy was performed. Histologically, the lesion proved to be a moderately differentiated adenocarcinoma invading the subserosa. The barium enema x-ray film taken 23 months before was, and a flat elevated lesion with central depression, type IIa+IIc, sized 19×16 mm was detected at the same site. In this case, a superficical neoplasm with a central depression grew into advanced cancer, and the doubling time of this lesion was 7.6 months. Superficial lesions could have been the essential growth pathway to advanced cancer, and the growth and progress pattern of lesions were different from those of sessile lesions. However, reported cases, which can be studied and retrospectively evaluated by roentgenelogic findings are still rare. It is very important to accumulate these kids of cases for estimating the natural history of colorectal cancer.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 50(2), 115-119, 1997-02-01

    The Japan Society of Coloproctology

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