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经内镜超声引导下活检术前诊断为类似黏膜下肿瘤的直肠癌切除术。

Resection of rectal cancer resembling submucosal tumor that was preoperatively diagnosed with endoscopic ultrasound-guided biopsy.

作者信息

Tanio Akimitsu, Saito Hiroaki, Ashida Keigo, Urushibara Shouichi, Yamamoto Manabu, Tokuyasu Naruo, Sakamoto Teruhisa, Honjo Soichiro, Maeta Yoshihiko, Fujiwara Yoshiyuki

机构信息

Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.

出版信息

Surg Case Rep. 2017 Dec;3(1):84. doi: 10.1186/s40792-017-0362-7. Epub 2017 Jul 26.

DOI:10.1186/s40792-017-0362-7
PMID:28748455
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5529306/
Abstract

BACKGROUND

Colorectal cancer (CRC) resembling submucosal tumor (SMT; CRC/SMT) is very rare. Because its biopsy is challenging, accurate preoperative diagnosis is also very rare.

CASE PRESENTATION

A 55-year-old woman with a high serum carcinoembryonic antigen level underwent a computed tomography colonoscopy, which showed extrinsic rectum compression. A coronal magnetic resonance image showed a 4-cm low-intensity tumor between her rectum and sacrum. Endoscopic ultrasound (EUS) showed a 30-mm low-echoic lesion originating from the rectum. Pathological examination of specimen obtained with EUS-guided fine-needle aspiration biopsy (EUS-FNAB) revealed adenocarcinoma. Immunohistochemical staining showed the tumor to be positive for both CK20 and CDX2 and negative for CK7, indicating that it was a rectal cancer. We performed a laparoscopy-assisted low-anterior resection with dissection of the regional lymph nodes after eight chemotherapy cycles. Macroscopically, tumor was completely covered by normal rectal mucosa, but showed a 2-mm bulge on the mucosa. Histological examination revealed a moderately differentiated adenocarcinoma, mainly located at the subserosal layer and severely invaded to lymphatic and blood vessels. The mucosal layer was not exposed to the cancer components, and her postoperative course was uneventful.

CONCLUSION

EUS-FNAB was useful in preoperative accurate diagnosis of this very rare tumor. We also review the literature and discuss CRC/SMT.

摘要

背景

类似于黏膜下肿瘤的结直肠癌（CRC/SMT）非常罕见。由于其活检具有挑战性，术前准确诊断也极为罕见。

病例介绍

一名血清癌胚抗原水平升高的55岁女性接受了计算机断层结肠成像检查，结果显示直肠外部受压。冠状磁共振图像显示在其直肠和骶骨之间有一个4厘米的低强度肿瘤。内镜超声（EUS）显示一个起源于直肠的30毫米低回声病变。经EUS引导下细针穿刺活检（EUS-FNAB）获取的标本病理检查显示为腺癌。免疫组织化学染色显示肿瘤CK20和CDX2均为阳性，CK7为阴性，表明这是一例直肠癌。在进行了八个化疗周期后，我们实施了腹腔镜辅助低位前切除术并清扫区域淋巴结。肉眼可见，肿瘤完全被正常直肠黏膜覆盖，但在黏膜上有一个2毫米的隆起。组织学检查显示为中分化腺癌，主要位于浆膜下层，且严重侵犯淋巴管和血管。黏膜层未暴露于癌组织成分，其术后病程平稳。

结论

EUS-FNAB有助于对这种非常罕见的肿瘤进行术前准确诊断。我们还回顾了文献并讨论了CRC/SMT。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/709cc74ad7ab/40792_2017_362_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/001bdbfcf0a8/40792_2017_362_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/3ed2185b9083/40792_2017_362_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/0d0ab7f897c7/40792_2017_362_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/00bc34e3f5c1/40792_2017_362_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/709cc74ad7ab/40792_2017_362_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/001bdbfcf0a8/40792_2017_362_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/3ed2185b9083/40792_2017_362_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/0d0ab7f897c7/40792_2017_362_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/00bc34e3f5c1/40792_2017_362_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd88/5529306/709cc74ad7ab/40792_2017_362_Fig5_HTML.jpg

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