Fukushima Hirofumi, Murakami Takashi, Suzuki Nobuyuki, Shibuya Tomoyoshi, Yao Takashi, Nagahara Akihito
Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan.
Department of Human Pathology Juntendo University School of Medicine Tokyo Japan.
JGH Open. 2021 Aug 11;5(9):1103-1105. doi: 10.1002/jgh3.12635. eCollection 2021 Sep.
McKittrick-Wheelock syndrome (MWS) is a rare entity that has been described as electrolyte and fluid depletion secondary to secretory diarrhea caused by a large villous tumor in the colon or rectum. Most tumors associated with MWS are large but benign villous adenomas. Advanced cancers are seldom reported. We report a rare case of advanced rectal cancer with multiple liver and bone metastases presenting with MWS. A 59-year-old man was admitted to our hospital with a more than 3-year history of chronic mucous diarrhea. Laboratory data revealed hyponatremia, hypokalemia, hypochloremia, and renal failure. Based on the findings on colonoscopy, computed tomography, and magnetic resonance imaging, he was diagnosed with advanced rectal cancer with liver and bone metastases, and MWS. Following intravenous fluid treatment, abdominoperineal resection of the rectum with lymph node dissection was performed. The surgically resected specimen was a circumferential villous tumor measuring 110 × 80 mm. Histological examination of the resected specimens revealed signet ring cell carcinoma with villous adenoma and metastasis in regional lymph nodes. The renal dysfunction and electrolyte abnormalities that were present before surgery improved. Two courses of capecitabine were administered as adjuvant chemotherapy after the surgery. However, approximately 2 months after surgery, he died of poor general condition due to progression of the liver metastases.
麦基特里克 - 惠洛克综合征（MWS）是一种罕见病症，被描述为结肠或直肠的大绒毛状肿瘤导致分泌性腹泻继发的电解质和液体耗竭。与MWS相关的大多数肿瘤较大但为良性绒毛状腺瘤。晚期癌症鲜有报道。我们报告一例罕见的晚期直肠癌伴多发肝和骨转移并表现为MWS的病例。一名59岁男性因慢性黏液性腹泻病史超过3年入院。实验室检查结果显示低钠血症、低钾血症、低氯血症和肾衰竭。基于结肠镜检查、计算机断层扫描和磁共振成像的结果，他被诊断为晚期直肠癌伴肝和骨转移以及MWS。经静脉补液治疗后，行腹会阴联合直肠癌根治术并清扫淋巴结。手术切除的标本是一个大小为110×80毫米的环形绒毛状肿瘤。切除标本的组织学检查显示印戒细胞癌伴绒毛状腺瘤且区域淋巴结有转移。术前存在的肾功能不全和电解质异常得到改善。术后给予两疗程的卡培他滨辅助化疗。然而，术后约2个月，他因肝转移进展导致全身状况不佳而死亡。
