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症例は59歳,女性.左上腹部腫瘤と食欲不振を主訴に当院受診.既往歴として48歳時に左胸水に対し他院入院加療.腹部CT検査では左上腹部に小児頭大の不整形な充実性腫瘍が認められ,全身麻酔下に開腹したところ左横隔膜下・胃前面に小児頭大・表面不整・易出血性・淡黄白色の腫瘍が認められた.腫瘍は左横隔膜に強固に浸潤し多数の腹膜播種を伴い,術中迅速病理診断で胸腺腫と判明したため,腫瘍および腹膜播種を可及的に摘出するに留めた.術後胸部X線を再検討したところ左上縦隔に腫瘍像が認められた.胸部CT検査で前縦隔に横隔膜へと続く腫瘍像が認められ,浸潤性胸腺腫が横隔膜へ直接浸潤し腹腔内進展・腹膜播種したものと考えられた.化学療法を行い残存腫瘍は縮小傾向にあり,術後9カ月生存中である.

原発性小腸癌は消化管悪性腫瘍の中で稀な疾患であり,臨床症状や理学的所見に乏しく,内視鏡検査や生検も施行しにくいため,術前診断することが極めて困難である.また一般に腹部超音波検査は,腸管ガスが存在するため消化管病変を描出することが困難である.今回われわれは,腹部超音波検査を契機に回腸癌と術前診断された症例を経験したので若干の文献的考察を加え報告する. 症例は69歳,女性.慢性C型肝炎で前医通院中に腹部超音波検査で回腸末端の壁肥厚と周囲リンパ節腫大を指摘され,精査目的で当科紹介となった.小腸造影検査や内視鏡検査の結果,回腸癌と術前診断され,結腸右半切除術を施行した.

A case of primary T cell of the small intestine with perforated peritonitis is reported. A 26-year-old man who had 2-month lasting poor appetite, high fever of unknown origine, and abdominal pain lost his body weight by 6kg, and the abdominal pain spreaded entire the abdomen one day before adomission. The patient was admitted to the hospital with a suspicion of peritonitis. Plain abdominal X-ray films and computed tomography revealed remarkable ascites and free air. Emergency laparotomy was performed under a diagnosis of perforative peritonitis. Two sites of perforations associated with ulceration were present in the small intestine approximetely 15cm and 80cm from the ligament of Treiz. Partial resections of the small intestine were performed. A histological diagnosis of diffuse lymphoma, mixed-sized, T cell type was confirmed from the positive findings immunochemical stain with UCHL1. The patient was discharged from the hospital 36days after operation. A total of 15 cases of primary T cell lymphoma of the small intestine including our case have been reported in the Japanese literature.

Ten cases of thyroid carcinoma with squamous metaplasia were divided into two groups according to the prognosis. The average age of 5 cases with good prognosis was 54.8. Because of negative or slight, if any, invasion to surrounding tissue, successive curative resection was done in all of those cases. All of them were papillary carcinoma with squamous metaplasia. Five cases with poor prognosis had the average age of 65. Complete resection was impossible for all of those cases due to severe invasion to various tissues. Histological evidence of undifferentiated carcinoma was revealed more or less in those 5 cases. Therefore the presence of squamous metaplasia does not influence on the prognosis of the patients. The comment in the WHO classification that the term “squamous cell carcinoma” should be reserved for tumours composed entirely of cells showing so-called intercellular bridge and/or forming keratin, and should not be used for a squamous component with papillary carcinoma of undifferentiated carcinoma has been reaffirmed.

A case of adenocarcinoma of Meckel's diverticulum is reported. A 62-year-old female was admitted to the hospital because of abdominal pain, nausea and vomiting. X-ray film of the small intestine showed an abdominal radiopaque retention like a diverticulum. CT showed a solid intrapelvic tumor. The patient was suspected as having a tumor derived from intestinal diverticulum. On the 4th day of hospital course, emergency operation was performed for perforated peritonitis. At laparotomy, Meckel's diverticulum was found 70cm orally from the Bauhin's valve on the antimesenteric border. An egg-sized tumor was found at the apex of the diverticulum, and there was a perforation in the middle of the diverticulum. No macroscopic metastasis was found. Partial resection of the ileum including the Meckel's diverticulum was performed. Pathological examination of the resected tumor revealed various morphology consisting of well and poorly differentiated adenocarcinoma. There existed ectopic gastric mucosa in the diverticulum, from where the tumor might arise. Nine months after the operation, she died of recurrence. This paper also presents a review of 14 domestic reports of adenocarcinoma of Meckel's diverticulum.