Park S S, Kim B K, Kim C J, Kim W S, Kim I O, Park K W, Shin H Y, Ahn H S
Department of Pathology, Seoul National University Children's Hospital College of Medicine, Korea.
J Korean Med Sci. 2000 Aug;15(4):475-7. doi: 10.3346/jkms.2000.15.4.475.
Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.
随着儿童恶性肿瘤治疗方法的改进，过去30年生存率的显著提高导致了发生第二原发性恶性肿瘤（SMN）的风险增加。我们报告一例横纹肌肉瘤治疗后发生的结直肠癌作为SMN。该患者3岁时被诊断为膀胱横纹肌肉瘤，13年后结肠发生腺癌。手术标本的组织学检查显示累及直肠乙状结肠区域的腺癌，背景为放射性结肠炎。肿瘤细胞对p53蛋白显示强免疫反应性，提示辐射和p53突变在致癌过程中的作用。该病例强调了对接受放疗和多药化疗的幼儿期恶性肿瘤幸存者进行剂量观察的必要性。
