Amano Yuki, Naito Masanori, Oshima Ryuichi, Negishi Hiroyuki, Kikuchi Yusuke, Katsumata Kenta, Usui Sota, Chosokabe Motohiro, Furuhata Tomohisa, Kokuba Yukihito, Otsubo Takehito
Division of Gastroenterological and General Surgery, St. Marianna University Yokohama Seibu Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1790-1792.
A woman in her 80s was diagnosed with an abdominal mass during physical examination. Contrast-enhanced computed tomography(CT)revealed a tumor with contrast enhancement outside the ileocecal region of the intestine, and the ileocolic artery penetrated the tumor. No tumor was detected by colonoscopy. An endoscope could not be passed through due to an ileocecal valve stenosis. A biopsy of the ileocecal valve revealed only lymphocyte hyperplasia without adenocarcinoma components. Barium enema examination demonstrated no influx of the contrast medium from the cecum into the oral side of the intestine. Since a gastrointestinal stromal tumor in the ileocecal region was suspected, laparotomy was performed in the ileocecal region owing to the preoperative diagnosis of suspected malignant lymphoma, revealing a 5-cm elastic hard tumor outside the ileocecal wall. The tumor could not be separated from the intestinal tract. Histopathological examination revealed no lesion on the mucosal surface, although poorly differentiated adenocarcinoma infiltrated from the submucosa to the serosa. Thus, the patient was diagnosed with extramural growth-type ileocecal colon cancer. This disease is relatively rare but need to be kept in mind.
一名80多岁的女性在体检时被诊断出腹部有肿块。增强计算机断层扫描（CT）显示，在回盲部肠管外有一个有强化的肿瘤，回结肠动脉穿过该肿瘤。结肠镜检查未发现肿瘤。由于回盲瓣狭窄，内镜无法通过。回盲瓣活检仅显示淋巴细胞增生，无腺癌成分。钡灌肠检查显示造影剂未从盲肠流入肠管的口侧。由于怀疑回盲部有胃肠道间质瘤，因术前诊断为疑似恶性淋巴瘤，故在回盲部进行了剖腹手术，发现回盲壁外有一个5厘米的弹性硬肿瘤。肿瘤无法与肠道分离。组织病理学检查显示黏膜表面无病变，尽管低分化腺癌从黏膜下层浸润至浆膜层。因此，该患者被诊断为壁外生长型回盲部结肠癌。这种疾病相对罕见，但需要牢记。
