Hakoda Keishi, Yoshimitsu Masanori, Emi Manabu, Hirai Yuya, Kamigaichi Atsushi, Osawa Manato, Kuraoka Norimasa, Komo Toshiaki, Tsubokawa Norifumi, Yamakita Ichiko, Miguchi Masashi, Aoki Yoshiro, Nakashima Akira, Kano Mikihiro, Oishi Koichi, Kohashi Toshihiko, Kaneko Mayumi, Funakoshi Mahito, Hihara Jun, Mukaida Hidenori, Hirabayashi Naoki
Dept. of Surgery, Hiroshima City Asa Citizens Hospital.
Gan To Kagaku Ryoho. 2017 Nov;44(12):1364-1366.
Anal metastasis of colorectal cancer is rare, and no standardized effective therapeutic strategy exists. We report a case of abdominoperineal resection for anal metastasis of rectal cancer. A 65-year-old man underwent laparoscopic low anterior resection for rectal cancer in August 2013. Histopathological examination revealed a moderately differentiated adenocarcinoma( tub2, pSS, ly3, v2, pN1, H0, P0, M0, Stage III a, Cur A). In February 2015, he complained of anal discomfort, and tumor markers were elevated. Enhanced CT revealed a 15-mm high-density solid tumor in the anal canal. The results of needle biopsy indicated a moderately differentiated adenocarcinoma. This tumor was suspected to be metastasis from rectal cancer, and we performed abdominoperineal resection. Histopathological examination revealed a moderately differentiated adenocarcinoma, which was the same histological type as the primary rectal cancer and was covered with normal anal epithelium. Collectively, the findings indicated anal metastasis from rectal cancer. The patient is alive without recurrence for 18 months after resection. Anal metastasis should be considered as a differential diagnosis in patients with anal discomfort who have a history of colon/rectal cancer. Abdominoperineal resection may be an effective treatment modality for this condition.
结直肠癌的肛门转移罕见，且不存在标准化的有效治疗策略。我们报告一例因直肠癌肛门转移而行腹会阴联合切除术的病例。一名65岁男性于2013年8月因直肠癌接受腹腔镜低位前切除术。组织病理学检查显示为中分化腺癌（tub2，pSS，ly3，v2，pN1，H0，P0，M0，Ⅲa期，Cur A）。2015年2月，他主诉肛门不适，肿瘤标志物升高。增强CT显示肛管有一个15毫米的高密度实性肿瘤。针吸活检结果显示为中分化腺癌。该肿瘤怀疑为直肠癌转移，我们进行了腹会阴联合切除术。组织病理学检查显示为中分化腺癌，其组织学类型与原发性直肠癌相同，且被正常肛门上皮覆盖。总体而言，这些发现提示为直肠癌的肛门转移。患者术后存活18个月无复发。对于有结肠/直肠癌病史且有肛门不适的患者，应考虑肛门转移作为鉴别诊断。腹会阴联合切除术可能是治疗这种情况的有效治疗方式。
