Niwa Koichiro, Sakamoto Kazuhiro, Goto Michitoshi, Kojima Yutaka, Takahashi Makoto, Ishiyama Shun, Kawai Masaya, Okazawa Yuu, Tomita Natumi, Seki Eiichiro, Fukumura Yuki, Yao Takashi
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Gastroenterological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Surg Case Rep. 2020 Jul 23;6(1):181. doi: 10.1186/s40792-020-00942-6.
Endosalpingiosis in the lymph nodes of the mesocolon is very rare. We reported a case with appendiceal endometriosis who had endosalpingiosis in the lymph nodes of the mesocolon that was found during laparoscopic ileocecal resection.
The patient was a 44-year-old woman who had visited a physician for fever, bloody stool, and abdominal pain 1 year earlier. She was diagnosed with ulcerative colitis on colonoscopy, and symptoms improved with oral treatment. A colonoscopy performed 2 months after diagnosis detected a hard, 20-mm submucosal tumor (SMT) in the cecum. On abdominal contrast CT, an intensely stained mass, including a low-density region, was observed in the cecum. A boring biopsy was performed after mucosal resection of the cecal SMT at our hospital, but diagnosis could not be made. Since the possibility of a malignant lesion could not be ruled out, laparoscopic ileocecal resection was performed. In the resected specimen, a 29 × 27 × 21-mm mass was present in the appendicular root. On histopathological examination, appendiceal endometriosis and endosalpingiosis in the lymph nodes around the ileocolic artery were observed. The postoperative course was favorable, and the patient was discharged 7 days after surgery.
Differentiation of endosalpingiosis in lymph nodes in the mesocolon from lymph node metastasis of adenocarcinoma is important in patients with an abdominal mass.
结肠系膜淋巴结内的输卵管内膜异位症非常罕见。我们报告了一例阑尾子宫内膜异位症患者，在腹腔镜回盲部切除术中发现其结肠系膜淋巴结存在输卵管内膜异位症。
患者为一名44岁女性，1年前因发热、便血和腹痛就医。结肠镜检查诊断为溃疡性结肠炎，经口服治疗后症状改善。诊断后2个月进行的结肠镜检查发现盲肠有一个20毫米的坚硬黏膜下肿瘤（SMT）。腹部增强CT显示盲肠有一个强化肿块，包括一个低密度区域。我院在对盲肠SMT进行黏膜切除后进行了穿刺活检，但未能明确诊断。由于不能排除恶性病变的可能性，遂进行了腹腔镜回盲部切除术。在切除标本中，阑尾根部有一个29×27×21毫米的肿块。组织病理学检查发现阑尾子宫内膜异位症以及回结肠动脉周围淋巴结的输卵管内膜异位症。术后病程顺利，患者术后7天出院。
对于有腹部肿块的患者，区分结肠系膜淋巴结内的输卵管内膜异位症与腺癌的淋巴结转移很重要。
