Imaeda Yoshihiro, Arakawa Satoshi, Yasuoka Hironobu, Kato Hiroyuki, Nagata Hidetoshi, Asano Yukio, Kawabe Norihiko, Shiogama Kazuya, Urano Makoto, Inada Ken-Ichi, Tsukamoto Tetsuya, Horiguchi Akihiko
Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan.
Faculty of Medical Technology, Fujita Health University, School of Health Sciences, Toyoake, Aichi, Japan.
Fujita Med J. 2022 Nov;8(4):134-138. doi: 10.20407/fmj.2021-013. Epub 2022 Jan 25.
Heterotopic ossification (HO), which occurs when bone tissue forms outside the skeleton, is extremely rare in rectal cancer. Adenocarcinoma is the histological type of all reported primary colorectal cancers with HO. However, in the present case, we observed areas of adenocarcinoma with squamous cell carcinoma-like differentiation. Here we conducted histopathological and immunohistochemical analyses to identify the mechanisms of HO development, to differentiate between adenocarcinoma and squamous cell carcinoma-like phenotypes, and to understand the associated prognostic implications.
A 62-year-old woman was admitted to our hospital with symptoms of intermittent hematochezia without abdominal pain. Colonoscopy revealed stenosis with a protuberant mass in the rectum. Abdominopelvic contrast-enhanced computed tomography showed irregular wall thickness of the rectum, multiple lymph node metastases, and liver metastases. The rectal tumor exhibited calcified deposits with marked hyperintensity. We then performed Hartmann's operation and D3 lymph node resection. The biopsy specimen revealed tubular and solid adenocarcinoma nests and squamous carcinoma-like components over a necrotic extent without secreted mucin. She received chemotherapy (mFOLFOX6 with bevacizumab) as the first option and is alive 5 months after surgery.
To the best of our knowledge, this is the first case of heterotopic ossification in a primary rectal cancer with squamous cell carcinoma-like differentiation that was surgically resected. This case suggests that BMP-2 transformed fibroblasts and pluripotent stem cells into osteocytes. We conclude that the squamous cell carcinoma-like lesion was squamous metaplasia of adenocarcinoma.
异位骨化(HO)是指骨组织在骨骼外形成,在直肠癌中极为罕见。腺癌是所有报道的伴有HO的原发性结直肠癌的组织学类型。然而,在本病例中,我们观察到腺癌区域伴有鳞状细胞癌样分化。在此,我们进行了组织病理学和免疫组化分析,以确定HO发生的机制,区分腺癌和鳞状细胞癌样表型,并了解相关的预后意义。
一名62岁女性因间歇性便血且无腹痛症状入院。结肠镜检查显示直肠狭窄并伴有突出肿物。腹盆腔增强计算机断层扫描显示直肠壁厚度不规则、多发淋巴结转移和肝转移。直肠肿瘤表现为钙化沉积物,呈明显高信号。随后我们进行了Hartmann手术和D3淋巴结切除术。活检标本显示在坏死区域有管状和实性腺癌巢以及鳞状癌样成分,无黏液分泌。她接受了化疗(mFOLFOX6联合贝伐单抗)作为首选治疗,术后5个月仍存活。
据我们所知,这是首例手术切除且伴有鳞状细胞癌样分化的原发性直肠癌发生异位骨化的病例。该病例提示骨形态发生蛋白-2将成纤维细胞和多能干细胞转化为骨细胞。我们得出结论,鳞状细胞癌样病变是腺癌的鳞状化生。