Tawada Masahiro, Misao Yuki, Ichikawa Kengo, Tanaka Hidenori
Department of Surgery, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, Gifu 500-8523, Japan.
Department of Surgery, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, Gifu 500-8523, Japan.
Int J Surg Case Rep. 2020;75:16-22. doi: 10.1016/j.ijscr.2020.08.061. Epub 2020 Sep 2.
Vitelline duct remnant (VDR) is a rare abnormality of the primitive yolk sac, and Meckel's diverticulum (MD) is the most common type. MD is a congenital small intestinal diverticulum that leaves the ileal side of vitelline duct, and MD adenocarcinoma is extremely rare.
A 49 year-old-man with abdominal mass was diagnosed as a huge pelvic tumor. We resected this tumor together with the invading ileum and the ileocecum. On histopathological and immunohistochemical analysis, tumor was diagnosed as adenocarcinoma and originated from the digestive tract. Considering that the cord extending from the umbilicus was connected to the tumor and that the tumor invaded the terminal ileum, we made a diagnosis of MD adenocarcinoma accompanied with the umbilical side of VDR and the huge cystic lesion bloated by tumor components filling up the duct due to cancer progression.
The reported occurrence of MD tumors is 0.5%-3.2%. The incidence of adenocarcinoma is 21.7% for the malignant tumors in MD. It is likely that a highly advanced local invasion and lymph node metastases are involved and that the prognosis of this adenocarcinoma is poor. There is no recommended chemotherapeutic regimen for MD adenocarcinoma. It is expected that cases should be accumulated in the future for the development of a more optimally recommended regimen.
Although the incidence of our case is extremely rare, the recognition of tumor development of the embryonic remnant origin is considered important for the treatment of this adenocarcinoma.
卵黄管残余（VDR）是原始卵黄囊的一种罕见异常，梅克尔憩室（MD）是最常见的类型。MD是一种先天性小肠憩室，位于卵黄管的回肠侧，MD腺癌极为罕见。
一名49岁男性因腹部肿块被诊断为巨大盆腔肿瘤。我们切除了该肿瘤以及受侵犯的回肠和回盲部。经组织病理学和免疫组织化学分析，肿瘤被诊断为腺癌，起源于消化道。考虑到从脐部延伸的条索与肿瘤相连且肿瘤侵犯回肠末端，我们诊断为MD腺癌，伴有VDR的脐侧以及因癌症进展肿瘤成分充满管道而膨胀的巨大囊性病变。
报道的MD肿瘤发生率为0.5%-3.2%。MD恶性肿瘤中腺癌的发生率为21.7%。很可能涉及高度进展的局部侵犯和淋巴结转移，且这种腺癌的预后较差。目前尚无针对MD腺癌的推荐化疗方案。预计未来应积累病例以制定更优化的推荐方案。
尽管我们的病例发生率极低，但认识胚胎残余起源的肿瘤发生情况对于该腺癌的治疗具有重要意义。
