A Case of Anal Metastasis from Rectal Cancer

症例は68歳男性で，痔瘻を含め肛門疾患の既往はなかった．3か月前からの肛門部の排膿を主訴に近医を受診した．肛門周囲膿瘍の診断で切開排膿をうけたが治癒せず，当院に紹介された．肛門右側に約15cmの硬い腫瘤を認め，同部の生検は腺癌であった．CT所見では肛門右側の腫瘤と直腸S状部に壁肥厚を認めた．肛門部腫瘤の圧排のため大腸内視鏡の挿入は不可能であった．検索は不十分であったが肛門癌および直腸S状部癌の診断で腹会陰式直腸切断術を施行した．骨盤底形成には右腹直筋皮弁を用いた．肉眼的に直腸S状部に2型の腫瘍を認めた．肛門部の粘膜には肛門周囲腫瘤による圧排を認めるのみであった．直腸S状部癌は中分化型腺癌で肛門部腫瘍も同様の組織型であっため直腸癌および同時性肛門転移と診断した．自験例のように肛門疾患の既往のない症例の大腸癌肛門転移はまれと考えられた．

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