Watanabe Ichiro, Yamauchi Hayato, Iwamasa Kikue, Kohno Masashi, Takada Kiyonori, Sugita Atsuro
First Department of Internal Medicine, Ehime University School of Medicine.
Nihon Ronen Igakkai Zasshi. 2002 Sep;39(5):549-53. doi: 10.3143/geriatrics.39.549.
An 86-year-old woman was admitted because of right lower abdominal pain. A 7 by 6 cm tumor palpable in the right lower quadrant was poorly mobile. Abdominal CT scan showed a huge tumor with a strong enhancement effect. Barium enema and colonoscopic examination revealed a submucosal tumor located from the cecum to the ascending colon on the oral side. An undifferentiated adenocarcinoma was suspected after examination of the biopsy specimen, right hemicolectomy was performed. The tumor invaded the retroperitoneal membrane. Histological examination showed a very atypical carcinoid tumor with central necrosis invading the veins. Pathohistologically, the huge tumor was diagnosed as endocrine cell carcinoma or atypical carcinoid. Furthermore, an elevated lesion, 2.5 cm in size, was revealed in the cecum closed to the huge tumor. Histological examination showed that the polypoid lesion was early moderately differentiated adenocarcinoma. There was no transition between the two tumors. The patient was discharged, but died of local recurrence 9 months after the surgery. Endocrine cell carcinoma of the large bowel is rare, in particular of the ileocecal region. Endocrine cell carcinoma of the ileocecal region adjacent to an adenocarcinoma without transition had not been reported previously in Japan.
一名86岁女性因右下腹痛入院。右下象限可触及一个7×6厘米的肿瘤，活动度差。腹部CT扫描显示一个巨大肿瘤，有强烈的强化效应。钡灌肠和结肠镜检查显示，在口侧从盲肠到升结肠有一个黏膜下肿瘤。活检标本检查后怀疑为未分化腺癌，遂行右半结肠切除术。肿瘤侵犯了腹膜后膜。组织学检查显示为非常不典型的类癌肿瘤，伴有中央坏死并侵犯静脉。病理组织学上，巨大肿瘤被诊断为内分泌细胞癌或不典型类癌。此外，在靠近巨大肿瘤的盲肠发现一个2.5厘米大小的隆起病变。组织学检查显示息肉样病变为早期中分化腺癌。这两个肿瘤之间没有过渡。患者出院，但术后9个月死于局部复发。大肠内分泌细胞癌罕见，尤其是在回盲部。在日本，此前尚未报道过与腺癌相邻且无过渡的回盲部内分泌细胞癌。
