Gadacz T R, McFadden D W, Gabrielson E W, Ullah A, Berman J J
Department of Surgery, Baltimore Veterans Administration Medical Center, University of Maryland.
Surgery. 1990 Jun;107(6):698-703.
A case of a primary adenocarcinoma of an ileostomy is reported along with 15 other cases collected from the literature. These rare tumors are seen on the average 24 years after colectomy with ileostomy and in all cases are associated with a past history of ulcerative colitis or familial polyposis. Most of the reported cases of these tumors have appeared in the literature within the past 5 years, suggesting that there is a rising incidence of this disease corresponding to completion of a biologic latency period that began when the Brooke ileostomy was introduced for ulcerative colitis in 1951. In our case a mucinous adenocarcinoma occurred at the ileostomy site 34 years after colectomy. Adjacent to the tumor was mucosa showing colonic metaplasia and focal dysplasia. Subsequent biopsy specimens of the revised stoma showed inflammatory lesions morphologically suggestive of inflammatory (pseudo) polyps. The clinical and morphologic features in this case suggest that there is transition from ileal mucosa to colonic mucosa to colonic dysplasia to adenocarcinoma. Annual evaluation of the ileostomy for colonic metaplasia, inflammatory lesions consistent with ulcerative colitis and dysplasia, is recommended. In the presence of dysplasia, stomal revision is advised. Wide local excision is advised for adenocarcinoma.
本文报告了一例回肠造口原发性腺癌病例，并从文献中收集了其他15例病例。这些罕见肿瘤平均在结肠切除术后回肠造口24年时出现，且所有病例均有溃疡性结肠炎或家族性息肉病病史。过去5年内，文献中报道了大多数此类肿瘤病例，这表明该疾病发病率上升，与1951年因溃疡性结肠炎采用布鲁克回肠造口术开始的生物学潜伏期结束相对应。在我们的病例中，结肠切除术后34年，回肠造口部位发生了黏液腺癌。肿瘤旁黏膜显示结肠化生和局灶性发育异常。修订造口术后的后续活检标本显示炎症性病变，形态学上提示炎性（假）息肉。该病例的临床和形态学特征表明，存在从回肠黏膜到结肠黏膜、再到结肠发育异常、最后到腺癌的转变。建议每年对回肠造口进行评估，以检查结肠化生、与溃疡性结肠炎一致的炎性病变和发育异常。若存在发育异常，建议修订造口。对于腺癌，建议进行广泛局部切除。
