Tschann P, Lechner D, Feurstein B, Abendstein B, Dertinger S, Bösl A, Vitlarov N, Offner F, Königsrainer I
Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
Department of Gynaecology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
J Med Case Rep. 2020 Feb 14;14(1):30. doi: 10.1186/s13256-020-2348-5.
Squamous cell carcinomas of the rectum are extremely rare and their pathogenesis is still under debate. Their proper diagnosis and treatment may thus be challenging.
A 52-year-old Caucasian woman was transferred to our department with a history of pelvic pain. Colonoscopy revealed a small tumorous lesion of the upper rectum and an endoscopic biopsy showed infiltration of the rectal mucosa by a squamous cell carcinoma. Afterward, tumorous lesions were found on imaging in both her ovaries. A laparoscopy with adnexectomy and anal mapping was performed and revealed tumor masses of squamous cell carcinoma in both ovaries. Based on the large size of the ovarian tumors and the concurrence of extensive, partly ciliated, macrocystic epithelium in one of the ovaries, a diagnosis of ovarian squamous cell carcinoma arising from a mature teratoma was rendered. However, human papillomavirus genotyping analyses were positive for human papillomavirus-16 in both the rectal tumor and ovarian tumors leading to a final diagnosis of a human papillomavirus-associated rectal squamous cell carcinoma metastatic to both ovaries. Neoadjuvant chemoradiation therapy of her rectum, total mesorectal excision, and hysterectomy were performed followed by adjuvant chemotherapy.
Colorectal squamous cell carcinoma is a rare disease. In cases of colorectal squamous cell carcinoma, metastatic disease at any other location has to be excluded. Human papillomavirus genotyping is essential in this context. Discussion of the treatment strategies should be interdisciplinary and include chemoradiation therapy and radical surgery.
直肠鳞状细胞癌极为罕见，其发病机制仍存在争议。因此，对其进行准确诊断和治疗可能具有挑战性。
一名52岁的白种女性因盆腔疼痛病史被转至我科。结肠镜检查发现直肠上段有一个小肿瘤性病变，内镜活检显示直肠黏膜被鳞状细胞癌浸润。随后，影像学检查发现她的双侧卵巢均有肿瘤性病变。进行了腹腔镜附件切除术和肛门定位检查，结果显示双侧卵巢均有鳞状细胞癌肿瘤块。基于卵巢肿瘤的较大尺寸以及其中一个卵巢存在广泛的、部分有纤毛的大囊泡上皮，诊断为源自成熟畸胎瘤的卵巢鳞状细胞癌。然而，直肠肿瘤和卵巢肿瘤的人乳头瘤病毒基因分型分析均显示人乳头瘤病毒16阳性，最终诊断为转移至双侧卵巢的人乳头瘤病毒相关直肠鳞状细胞癌。对其直肠进行了新辅助放化疗、全直肠系膜切除术和子宫切除术，随后进行了辅助化疗。
结直肠鳞状细胞癌是一种罕见疾病。对于结直肠鳞状细胞癌病例，必须排除任何其他部位的转移性疾病。在这种情况下，人乳头瘤病毒基因分型至关重要。治疗策略的讨论应跨学科进行，包括放化疗和根治性手术。
