Liu Yu-Hong, Pu Ta-Wei, Yu Hsing-Wei, Kang Jung-Cheng, Yen Ching-Heng, Chen Chao-Yang
Department of Surgery, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC; School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC.
Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, Songshan Branch, No. 131, Jiankang Rd., Songshan District, Taipei City, 10581, Taiwan, ROC; School of Medicine, National Defense Medical Center, No. 131, Jiankang Rd., Songshan District, Taipei City, 10581, Taiwan, ROC.
Int J Surg Case Rep. 2021 May;82:105785. doi: 10.1016/j.ijscr.2021.105785. Epub 2021 Mar 16.
Bladder urothelial carcinoma rarely spreads to the gastrointestinal tract, and its presentation in the rectum varies. We report a case of a patient who presented with an annular constriction of the rectum.
A 60-year-old man was referred to our hospital with chief complaints of anal stricture and partial obstruction for about 1 month. Computed tomography and magnetic resonance imaging revealed diffuse wall thickening of the rectum, possible high cellularity in the lower portion of urinary bladder, and lesions in the visible pelvic bony structure. A colonoscopy showed a contiguous annular constriction from 5 to 15 cm above the anal verge. Carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 39.75 ng/mL and 139.2 U/mL, respectively. A transurethral bladder biopsy revealed high-grade urothelial cell carcinoma, and anal biopsy showed a poorly differentiated carcinoma arranged in a small nested pattern within the subepithelial area of the anorectal tissue. A colostomy was performed, and the patient was transferred to another hospital for further treatment after series of survey with lung metastasis.
Invasive bladder cancers rarely infiltrates into the rectum and is known with the difficulty diagnosis by colonoscopy. Furthermore, the secondary rectum tumor due to bladder cancer had poor record for survival in the literature review.
This case of bladder urothelial carcinoma penetrating to the rectum was interesting because it mimicked proctitis with diffuse annular swelling observed in the colonoscopy.
膀胱尿路上皮癌很少扩散至胃肠道，其在直肠的表现各异。我们报告一例表现为直肠环形狭窄的患者。
一名60岁男性因肛门狭窄和部分梗阻约1个月为主诉被转诊至我院。计算机断层扫描和磁共振成像显示直肠壁弥漫性增厚，膀胱下部可能细胞密度较高，以及可见盆腔骨质结构有病变。结肠镜检查显示在距肛缘5至15厘米处有连续的环形狭窄。癌胚抗原和糖类抗原19-9水平分别为39.75 ng/mL和139.2 U/mL。经尿道膀胱活检显示高级别尿路上皮癌，肛门活检显示低分化癌，呈小巢状排列于肛管直肠组织的上皮下区域。行结肠造口术，在一系列检查发现肺转移后，患者被转至另一医院进行进一步治疗。
浸润性膀胱癌很少浸润至直肠，且通过结肠镜检查难以诊断。此外，在文献综述中，膀胱癌继发的直肠肿瘤生存记录不佳。
该例膀胱尿路上皮癌侵犯至直肠的病例很有意思，因为在结肠镜检查中它类似直肠炎，表现为弥漫性环形肿胀。
