Kojima Yutaka, Matsumoto Fumio, Mikami Yoshi, Namekata Koji, Takei Masahiko
Department of Surgery, Koshigaya Municipal Hospital, Koshigaya City, Japan.
Case Rep Gastroenterol. 2010 Sep 15;4(3):340-345. doi: 10.1159/000320649.
We present the case of a 68-year-old female patient who was diagnosed with cancer of the descending colon in July 1994 and underwent partial resection of the colon (type 2, moderately to well differentiated adenocarcinoma, se, ly1, v1, n(-)). In April 1996, she was admitted to a nearby hospital for symptoms of ileus, which improved at the hospital. However, she was referred to our hospital for melena. In blood test, Hb was 8.7 g/dl, showing anemia, and carcinoembryonic antigen level was elevated to 50.7 ng/ml. Abdominal CT and small bowel series showed only mild expansion of the small bowel, suggesting no obvious occlusion. Abdominal surgery was performed in May 1995 for repeated development of ileus symptoms and suspicion of bleeding from the small bowel. Since the findings of the abdominal surgery showed a circular tumor in the lower ileum, partial resection of the small bowel was performed. Histopathological examination showed type 3, moderately to well differentiated adnocarcinoma, se, ly2, v0, n = 1/13. The principal tumor was located within the subserosa and grew up exclusively through the muscularis propria and the submucosa, into the mucous layer. The mucosa remained slightly on the surface layer. Based on these findings, the patient was diagnosed with metastasis of descending colon cancer to the small bowel. Her prognosis was good, and neither metastasis nor redevelopment of the cancer have been confirmed to date, 11 years and 7 months since the surgery.
我们报告一例68岁女性患者，她于1994年7月被诊断为降结肠癌，并接受了结肠部分切除术（2型，中分化至高分化腺癌，se，ly1，v1，n（-））。1996年4月，她因肠梗阻症状入住附近医院，在该院症状有所改善。然而，她因黑便被转诊至我院。血液检查显示，血红蛋白（Hb）为8.7g/dl，提示贫血，癌胚抗原水平升高至50.7ng/ml。腹部CT和小肠造影仅显示小肠轻度扩张，未提示明显梗阻。1995年5月，因肠梗阻症状反复出现且怀疑小肠出血，患者接受了腹部手术。腹部手术结果显示回肠下段有一环形肿瘤，遂行小肠部分切除术。组织病理学检查显示为3型，中分化至高分化腺癌，se，ly2，v0，n = 1/13。主要肿瘤位于浆膜下层，仅通过固有肌层和黏膜下层生长至黏膜层。黏膜表层仍稍有保留。基于这些发现，患者被诊断为降结肠癌转移至小肠。她的预后良好，自手术至今已过去11年7个月，未证实有转移或癌症复发。
