Virginia Commonwealth University Health System, Richmond, VA, USA.
Int J Surg Pathol. 2020 Jun;28(4):406-409. doi: 10.1177/1066896920903109. Epub 2020 Feb 2.
The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfalls, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the role of incidental seminal vesiculectomy in rectal resections due to fibrous adhesion to the rectal wall secondary to chemoradiation has not been studied. As the seminal vesicle epithelium can show markedly atypical nuclei with radiation-type effect at baseline, the potential risk of misinterpretation as residual adenocarcinoma is high. In this article, we present 2 case reports of rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy followed by transabdominal resection (low anterior resection or abdominopelvic resection) with incidental seminal vesiculectomies mimicking either residual adenocarcinoma or residual adenocarcinoma at a margin of resection.
对于 T3 期和 T4 期直肠腺癌，标准治疗方法包括新辅助放化疗，随后进行低位前切除术或腹会阴切除术。残留腺癌或阳性手术切缘提供了有用的预后信息，并可能影响正在进行的辅助治疗。尽管不常见，但治疗后的腺癌的模拟物可能存在于手术标本中。高度怀疑是避免潜在假阳性陷阱的关键，排除治疗后的腺癌的模拟物对于准确的诊断和治疗至关重要。精囊上皮一直是区分前列腺腺癌和良性上皮的一个挑战。然而，由于化学放射治疗导致直肠壁纤维粘连，偶然进行精囊切除术在直肠切除术中的作用尚未得到研究。由于精囊上皮在基线时可能显示出明显的非典型核，具有放射型效应，因此将其误诊为残留腺癌的风险很高。在本文中，我们报告了 2 例接受新辅助放化疗后行经腹切除术（低位前切除术或腹会阴切除术）的直肠腺癌病例，术中偶然进行了精囊切除术，模拟了残留腺癌或切缘残留腺癌。
