炎症性変化のため肉眼的にびまん浸潤型を呈した1型S状結腸癌の1例 A CASE OF SIGMOID COLON CARCINOMA ASSOCIATED WITH DIFFUSE INFLAMMATORY CHANGE
26歳の女性,便秘,腹痛を主訴に近医を受診.注腸で全周性狭窄と腸管外への造影剤漏出あり. Crohn病による狭窄,瘻孔が疑われ当院を紹介受診した.大腸内視鏡で不整な全周性狭窄があり中分化腺癌を認めた.びまん浸潤型S状結腸癌の診断で, S状結腸切除術を施行した.切除標本では8 cmにわたる全層性の著明な壁の肥厚を伴う狭窄を認めた.中央に2 cmの隆起性病変を伴っており4型に1型を伴った5型大腸癌と診断した.また隆起病変基部から腸管外の膿瘍に瘻孔を形成していた.病理所見では隆起性病変内に中分化腺癌の認めたが,周囲の壁の肥厚は全層性の非特異的炎症性変化で癌の浸潤は認めなかった.最終診断は1型, 2×2 cm, mp, n<sub>1</sub>(+), stage IIIa, cur Aで,化学療法施行し術後23カ月間無再発生存中である.炎症性変化のため肉眼的にびまん浸潤型を呈した分化型腺癌の報告は検索しえた限り本邦で8例のみであった.
A 26-year-old woman admitted elsewhere for constipation, abdominal pain, and fever was found in a barium enema examination to have a marked stricture and fistula of the sigmoid colon, so she was referred to us for treatment with a tentative diagnoses of Crohn's disease. Colonoscopy showed an annular stricture from which moderatly differentiated adenocarcinoma was diagnosed. Accordingly, the tumor was recognized as diffuse infiltrating sigmoid colon cancer. Sigmoidectomy with D3 lymph node dissection was done. The resected specimen showed stenosis with thickening of the colonic wall, giving an impression of submucosal scirrhous infiltration of carcinoma, and a protruding tumor 2 cm in diameter was located at the center of the stenotic segment. Histologically, the protruding tumor was shown to be moderatly differentiated adenocarcinoma with invasion into the muscular layer, and stenosis around the tumor showed inflammatory change without malignant cells. The pathological diagnosis was type 1, 2×2 cm, mp, n1 (+), stage IIIa, with nonspecific colitis. The patient has remained disease-free in the 23 months since surgery. Colon carcinoma with diffuse inflammation is rare, with only 8 cases, including ours, reported in the Japanese literature.
- 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 65(9), 2427-2430, 2004-09-25
Japan Surgical Association