Sato Yoshihiro, Tsujinaka Shingo, Miura Tomoya, Kitamura Yoh, Sawada Kentaro, Mitamura Atsushi, Yamamoto Kuniharu, Nakano Toru, Katayose Yu, Shibata Chikashi
Division of Gastroenterological and Hepato-biliary-Pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Sendai 983-8536, Miyagi, Japan.
J Surg Case Rep. 2024 Jul 13;2024(7):rjae457. doi: 10.1093/jscr/rjae457. eCollection 2024 Jul.
This study presents a case of a 72-year-old man diagnosed with non-small cell lung cancer (cT4N0M0) referred to our hospital for possible surgical treatment of a solitary nodule detected in the mesorectum. The patient had received combined chemoradiotherapy and achieved a complete response 13 months before the presentation. On examination, the mesorectal nodule was incidentally detected during surveillance computed tomography, and the maximum standardized uptake value of the nodule was 10.3. Because of the potential malignancy and need for en-bloc resection of the nodule, we performed laparoscopically assisted high anterior resection of the rectum. The postoperative course was uneventful. Notably, while pathological examination revealed that the mesorectal nodule comprised an intravenous organized thromboembolism, malignancy was not observed. These findings suggest that although positron emission tomography/computed tomography with F-fluorodeoxyglucose is useful for the diagnosis of malignant diseases, surgical resection might be the most reliable option for complex cases such as ours.
本研究报告了一例72岁男性患者，其被诊断为非小细胞肺癌（cT4N0M0），因直肠系膜中发现的孤立性结节可能需要手术治疗而转诊至我院。该患者在就诊前13个月接受了同步放化疗，并取得了完全缓解。检查时，直肠系膜结节是在监测计算机断层扫描时偶然发现的，结节的最大标准化摄取值为10.3。由于结节有潜在恶性可能且需要整块切除，我们进行了腹腔镜辅助下直肠高位前切除术。术后过程顺利。值得注意的是，病理检查显示直肠系膜结节由静脉内机化血栓栓塞组成，未观察到恶性病变。这些发现表明，尽管氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描对恶性疾病的诊断有用，但对于我们这样的复杂病例，手术切除可能是最可靠的选择。
