Takahashi Rina, Ichikawa Ryosuke, Ito Singo, Mizukoshi Kosuke, Ishiyama Shun, Sgimoto Kiichi, Kojima Yutaka, Goto Michitoshi, Tomiki Yuichi, Yao Takashi, Sakamoto Kazuhiro
Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Human Pathology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Surg Case Rep. 2015 Dec;1(1):123. doi: 10.1186/s40792-015-0125-2. Epub 2015 Dec 11.
This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery.
该病例涉及一名80岁男性，因黑便前来就诊。进一步检查发现直肠有一个大小为50毫米的管状腺癌。此外，在肛门后方发现一个肛瘘并伴有硬结。对肛瘘外口（继发开口）的组织进行活检也发现了腺癌。双肺野均发现疑似转移瘤的结节。该患者被诊断为直肠癌、肛瘘来源的癌以及转移性肺肿瘤，并开始进行新辅助化疗。在接受6个周期的mFOLFOX-6治疗34天后，进行了腹腔镜腹会阴联合切除术。根据病理结果，直肠癌被诊断为中分化腺癌，且该腺癌有淋巴结转移（yp T3N2aM1b）。直肠病变与肛瘘之间没有相通，在肛瘘中发现了一个与直肠病变相似的中分化管状腺癌。免疫组化染色显示直肠病变和肛瘘均为细胞角蛋白7（CK7）（-）和细胞角蛋白20（CK20）（+），患者的病情被诊断为直肠癌种植于肛瘘。在结肠癌发生肛瘘的情况下，也必须考虑癌在该肛瘘中的种植，术前应进行进一步检查。
