Wakatsuki Kazuo, Oeda Yoshio, Isono Toshio, Yoshioka Shigeru, Nukui Yuji, Yamazaki Kazuto, Nabeshima Seiya, Miyazaki Masaru
Department of Surgery, Chiba Municipal Kaihin Hospital, Mihama-ku, Chiba City, Chiba, 261-0012, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):952-5.
This paper reports a rare case of rectosigmoid colon carcinoma metastasizing to anal fistula. The patient is a 57-year old man with a 7-year history of a fistula in ano. Colonoscopy revealed a rectosigmoid carcinoma. He underwent high-anterior resection. Two years and 3 months later, a subcutaneous tumor was found at the external opening of fistula. Trans perineal tumor excision plus fistulectomy was performed. Pathology revealed that the colon cancer and the perianal tumor were both moderately differentiated adenocarcinoma. Many reports support the concept of tumor cell implantation in mucosa that have been altered or denuded by various factors. Sixteen reports could be found of implantation metastasis of colorectal cancer into anal fistula. In diagnosis, it is important to differentiate implantation of colorectal cancer in anal fistula from primary anal fistular adenocarcinoma. The histology of the perianal tumor in this patient closely resembles the tumor of the colon. Furthermore, immunohistochemistry for cytokeratins 7 and 20 was performed on tissues to distinguish colorectal adenocarcinoma from anal gland carcinoma. Both colorectal cancer and perianal tumor showed CK7-/CK20+.
本文报道了一例罕见的直肠乙状结肠癌转移至肛瘘的病例。患者为一名57岁男性，有7年肛瘘病史。结肠镜检查发现直肠乙状结肠癌。他接受了高位前切除术。两年零三个月后，在肛瘘外口发现一个皮下肿瘤。进行了经会阴肿瘤切除加肛瘘切除术。病理显示结肠癌和肛周肿瘤均为中分化腺癌。许多报告支持肿瘤细胞植入因各种因素而改变或剥脱的黏膜这一概念。可找到16篇关于结直肠癌植入转移至肛瘘的报告。在诊断中，将结直肠癌植入肛瘘与原发性肛瘘腺癌相鉴别很重要。该患者肛周肿瘤的组织学与结肠肿瘤极为相似。此外，对组织进行了细胞角蛋白7和20的免疫组化检测，以区分结直肠腺癌和肛管腺癌。结直肠癌和肛周肿瘤均显示CK7-/CK20+。
