Rudnicki Cezary, Romanowski Marek, Mędrek-Socha Marta, Stec-Michalska Krystyna
Assistant Lecturer, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland .
Junior Lecturer, Department of Gastroenterology, Medical University of Lodz , Lodz, Poland .
J Clin Diagn Res. 2015 Dec;9(12):OD01-3. doi: 10.7860/JCDR/2015/14589.6893. Epub 2015 Dec 1.
The clinical picture and risk factors are decisive in differential diagnosis. It was proved that patients with metabolic syndrome have increased incidence of malignant tumours. The visceral adipose tissue releases active proteins that promote oncogenesis. We are presenting a case of 34-year-old male with metabolic syndrome suffering from pain in left iliac fossa with accompanying variable stool pattern. At first, the sigmoid diverticulosis was suspected. Patient's condition after the treatment has improved. The ambulatory, partial colonoscopy revealed a cauliflower-like, balloting, wide-base growth in the sigmoid that narrowed its lumen. The biopsy did not reveal atypical growth characteristics. Because of tumour type and enlarged regional lymph nodes seen in abdomen CT scan, the segmental colon resection and end-to-end anastomosis was performed in the area of sigmoid-rectal junction. Macroscopically, there were no visible metastases in the operation field. The surgery and postoperative period ran without any complications. On histopathological examination, the removed tumour was a well differentiated liposarcoma (WDL) stemming unusually from adipose tissue of colonic submucosa in an obese male. WDL is a hard to diagnose tumour, especially in early stages of its growth. In the presented case, the tumour was completely resected.
临床表现和风险因素在鉴别诊断中起决定性作用。已证实代谢综合征患者患恶性肿瘤的几率增加。内脏脂肪组织会释放促进肿瘤发生的活性蛋白。我们现介绍一例34岁患有代谢综合征的男性患者,其左下腹疼痛并伴有大便习惯改变。起初怀疑为乙状结肠憩室病。治疗后患者病情有所改善。门诊进行的部分结肠镜检查显示,乙状结肠有一个菜花状、可移动、宽基底的肿物,使肠腔变窄。活检未发现非典型生长特征。由于肿瘤类型以及腹部CT扫描发现区域淋巴结肿大,在乙状结肠直肠交界处进行了节段性结肠切除和端端吻合术。肉眼观察,手术区域未见明显转移灶。手术及术后过程均无任何并发症。组织病理学检查显示,切除的肿瘤为高分化脂肪肉瘤(WDL),该肿瘤罕见地起源于一名肥胖男性结肠黏膜下层的脂肪组织。高分化脂肪肉瘤是一种难以诊断的肿瘤,尤其是在其生长早期。在本病例中,肿瘤已完全切除。