胃と腸48巻9号

2013年08月発行

症例

潰瘍性大腸炎に発生した直腸腫瘍の1例

著者： 久津川誠¹ 大塚和朗¹ 池田晴夫¹ 石田文生¹ 濱谷茂治² 工藤進英¹

所属機関： ¹昭和大学横浜市北部病院消化器センター ²昭和大学横浜市北部病院病理診断科

ページ範囲：P.1329 - P.1340

要旨　患者は51歳，女性．18歳で潰瘍性大腸炎と診断されたが，最近20年間は治療を受けていなかった．健診の便潜血反応が陽性のため，前医で下部消化管内視鏡検査が施行された．直腸に隆起性病変を認め，当センターを紹介された．当センターで再検し，隆起性病変（1）に加え，平坦型病変を2病変（病変（2），（3））認めた．生検で病変（1）は潰瘍性大腸炎関連大腸癌，病変（2）はdysplasiaと診断され，腹腔鏡補助下大腸全摘回腸囊肛門吻合術が施行された．病理組織学的には，病変（1）はSM深部浸潤癌，病変（2），（3）はlow to high grade dysplasiaであった．また内視鏡検査で指摘しうる範囲を超えた部位で，HE染色で診断できないp53陽性を示すlow grade dysplasiaを認めた．

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