Alfa-Wali Maryam, Muktar Samantha, Pissas Dimitrios, Slater Ceri
Imperial College London, London, UK.
Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, UK.
BMJ Case Rep. 2018 Mar 15;2018:bcr-2017-223944. doi: 10.1136/bcr-2017-223944.
A 48-year-old man presented as an emergency with a 3-week history of rectal bleeding. Examination of his rectum revealed a circumferential tumour, 2 cm from the anal verge. An MRI scan reported a locally infiltrative mid-lower rectal tumour staged as T3d/T4 N2 MX. A colonoscopy revealed appearances of severe proctitis and biopsies did not show any evidence of dysplasia or malignancy. The patient was discussed at the regional colorectal cancer multidisciplinary team meeting with a management plan for neoadjuvant chemoradiotherapy following repeat biopsies, which were again negative for malignancy. He tested positive for the HIV and was referred to genitourinary medicine. A positive nucleic acid test from a rectal swab was serovar L2 consistent with a diagnosis of lymphogranuloma venereum. He was treated with doxycycline and subsequent MRI scans showed reduction in tumour size with eventual resolution. This case report highlights the importance of HIV testing in patients with newly diagnosed colorectal tumours.
一名48岁男性因直肠出血3周前来急诊。直肠检查发现距肛缘2厘米处有一环形肿瘤。磁共振成像扫描报告显示为局部浸润性中低位直肠肿瘤，分期为T3d/T4 N2 MX。结肠镜检查显示为严重直肠炎表现，活检未发现发育异常或恶性肿瘤的证据。该患者在地区结直肠癌多学科团队会议上进行了讨论，计划在重复活检（结果仍为恶性阴性）后进行新辅助放化疗。他的艾滋病毒检测呈阳性，并被转诊至泌尿生殖医学科。直肠拭子核酸检测呈阳性，血清型为L2，符合性病性淋巴肉芽肿的诊断。他接受了强力霉素治疗，随后的磁共振成像扫描显示肿瘤大小缩小，最终消退。本病例报告强调了对新诊断结直肠肿瘤患者进行艾滋病毒检测的重要性。
