Kongkam P, LeBlanc J K
Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Endoscopy. 2008 Oct;40(10):873-4. doi: 10.1055/s-2008-1077468. Epub 2008 Jul 21.
Local recurrent rectal cancer may present with extraluminal lesions. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is good for diagnosis of such an extraluminal lesion. A 51-year-old Asian female was diagnosed with uT3N0M0 rectal adenocarcinoma 31 months ago. She had undergone chemotherapy, radiotherapy and abdominoperineal resection (APR). Eight months ago, colonoscopy and computed tomography (CT) were unremarkable. Carcinoembryonic antigen was 1.1 ng/ml. Pelvic examination revealed a 3 x 2 cm firm soft-tissue mass palpable through the left vaginal wall. EUS revealed a mass in the left lateral vaginal wall measuring up to 21 x 27 mm in cross section without invasion of adjacent pelvic structures. Transvaginal EUS-FNA was performed with a 22-gauge needle. Final cytology confirmed recurrent rectal adenocarcinoma. Subsequent surgery also confirmed a 2.3 cm grade II adenocarcinoma. The tumor focally extended to the inked margin. The uterus and ovary specimen were negative for disease. We herein report a successful role of transvaginal EUS-FNA for early detection of recurrent rectal cancer at the vaginal wall after abdominoperineal resection (APR).
局部复发性直肠癌可能表现为腔外病变。内镜超声引导下细针穿刺抽吸术（EUS-FNA）有助于诊断此类腔外病变。一名51岁的亚洲女性在31个月前被诊断为uT3N0M0直肠腺癌。她接受了化疗、放疗和腹会阴联合切除术（APR）。8个月前，结肠镜检查和计算机断层扫描（CT）均无异常。癌胚抗原为1.1 ng/ml。盆腔检查发现可通过左侧阴道壁触及一个3×2 cm的坚硬软组织肿块。EUS显示左侧阴道壁有一个肿块，横截面最大尺寸达21×27 mm，未侵犯相邻盆腔结构。使用22号针进行了经阴道EUS-FNA。最终细胞学检查确诊为复发性直肠腺癌。随后的手术也证实为2.3 cm的II级腺癌。肿瘤局部延伸至标记边缘。子宫和卵巢标本未发现病变。我们在此报告经阴道EUS-FNA在腹会阴联合切除术（APR）后早期检测阴道壁复发性直肠癌中的成功作用。
