Colitic Cancer with a Variety of Pathologies Arising in Ulcerative Colitis Patients-A Case Report

症例は53歳女性．約10年の潰瘍性大腸炎(UC）加療中，サーベイランス大腸内視鏡検査でdysplasia associated lesion or mass(DALM）を指摘．結腸全摘，直腸粘膜切除，J型回腸嚢肛門吻合術(IPAA）を施行．大腸に扁平上皮癌(粘膜切除部，直腸），粘液癌(下行結腸），高分化型腺癌(上行結腸，横行結腸）と多彩な病理形態のcancerを認めた．いずれもpM, pN0, stage Iで，良好に経過している．近年，サーベイランス大腸内視鏡の有用性が広く認識され，DALMが手術適応のUC症例は増加している．肛門温存術式が標準術式となっているが，IPAAまたは回腸嚢肛門管吻合(IACA）の選択には一定の見解が得られていない．肛門管粘膜の発癌に関しては低頻度であり，問題ないとする報告があるが，粘膜切除部に癌を認める症例も少なからず存在し,直腸粘膜切除が必要となる症例が存在するものと思われた．

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