Okada Susumu, Ohaki Yoshiharu, Inoue Kohei, Nakajo Hidenobu, Kawamata Hiroshi, Kumazaki Tatsuo
Department of Radiology, Nippon Medical School Chiba-Hokuso Hospital, 1715 Kamagari, Inba-mura, Inba-gun, Chiba 270-1694, Japan.
Radiat Med. 2005 Sep;23(6):443-6.
A 54-year-old woman complained of abdominal pain and watery diarrhea that had begun two days before admission. Physical examination revealed abdominal distention and tenderness throughout the abdomen, but there was no muscle guarding or rebound tenderness. The leukocyte count was 27.0 x 10(3)/microl, and CRP was 28.5 mg/dl. A plain film of the abdomen revealed the shadow of a huge gas-containing mass with an air-fluid level and a dilated small intestine with air-fluid level. CT showed a huge gas-containing cystic mass with fatty component and solid structure. Omental thickening was also noted. Emergency surgery was performed, and an enlarged left ovary that was adherent to the small intestine was removed. Microscopic examination revealed a squamous cell carcinoma in the dermoid cyst wall. The carcinoma had directly invaded the small intestine and a fistula between the cyst and the intestine was noted. Thickened omentum showed granulomatous inflammation in the fatty tissue, but no metastases were detected. The histopathological diagnosis was dermoid cyst with malignant transformation and invasion of the small intestine. Chemotherapy was performed, but the patient died of progression of peritoneal metastases 10 months after the operation.
一名54岁女性主诉入院前两天开始出现腹痛和水样腹泻。体格检查发现全腹膨隆且压痛，但无肌紧张或反跳痛。白细胞计数为27.0×10³/微升，CRP为28.5毫克/分升。腹部平片显示一个巨大的含气肿块阴影，伴有气液平面，以及扩张的小肠伴有气液平面。CT显示一个巨大的含气囊性肿块，有脂肪成分和实性结构。还发现网膜增厚。进行了急诊手术，切除了与小肠粘连的增大的左侧卵巢。显微镜检查显示皮样囊肿壁内有鳞状细胞癌。癌已直接侵犯小肠，且发现囊肿与小肠之间有瘘管。增厚的网膜在脂肪组织中显示肉芽肿性炎症，但未检测到转移。组织病理学诊断为皮样囊肿伴恶性转化并侵犯小肠。进行了化疗，但患者术后10个月死于腹膜转移进展。
