Tan Qirong, Zhou Jiaxin, Zhao Ke, Lian Shaoyan, Li Jieying, Huang Yuanyan, Qiu Chuhui, He Jiang, Liu Chaoqun
Department of Family Medicine, the University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Geriatric Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
AME Case Rep. 2024 May 24;8:63. doi: 10.21037/acr-23-207. eCollection 2024.
Solitary rectal ulcer syndrome (SRUS) is a rare chronic rectal lesion with potential for malignant transformation, although cases of rapid progression to mucinous adenocarcinoma are infrequent. This case report highlights such an instance in a 29-year-old male patient, emphasizing the importance of vigilance among clinicians for detecting canceration in SRUS patients.
The patient presented with recurrent constipation and anal discomfort, initially diagnosed with SRUS based on colonoscopy and pathological examination. Despite long-term mesalazine treatment, symptoms persisted, and subsequent evaluation revealed the development of mucinous adenocarcinoma within a short period. Surgical resection, combined with adjuvant FOLFOX chemotherapy, effectively controlled cancer progression. Immunohistochemical analysis showed positive expression of MLH1(+), MSH2(+), MSH6(+), PMS2(+), and HER2(+), providing molecular insights into SRUS-associated mucinous adenocarcinoma.
This case underscores the need for increased awareness among clinicians regarding the potential for cancerous transformation in SRUS patients. Early detection and intervention are crucial for improving outcomes in SRUS-associated malignancies. Furthermore, this case adds to existing literature by presenting a rare instance of SRUS progressing rapidly to mucinous adenocarcinoma, highlighting the significance of regular monitoring and timely intervention in such cases. Further research is warranted to elucidate underlying mechanisms and risk factors, guiding future clinical practice and treatment strategies.
孤立性直肠溃疡综合征（SRUS）是一种罕见的慢性直肠病变，有恶变潜能，尽管快速进展为黏液腺癌的病例并不常见。本病例报告突出了一名29岁男性患者的此类情况，强调了临床医生对SRUS患者癌变进行监测的重要性。
该患者表现为反复便秘和肛门不适，最初经结肠镜检查和病理检查诊断为SRUS。尽管长期使用美沙拉嗪治疗，症状仍持续存在，随后的评估显示短期内发生了黏液腺癌。手术切除联合辅助性FOLFOX化疗有效控制了癌症进展。免疫组化分析显示MLH1(+)、MSH2(+)、MSH6(+)、PMS2(+)和HER2(+)呈阳性表达，为SRUS相关黏液腺癌提供了分子层面的见解。
本病例强调临床医生需要提高对SRUS患者癌变可能性的认识。早期发现和干预对于改善SRUS相关恶性肿瘤的预后至关重要。此外，本病例通过呈现SRUS快速进展为黏液腺癌的罕见实例，丰富了现有文献，突出了对此类病例进行定期监测和及时干预的重要性。有必要进行进一步研究以阐明潜在机制和危险因素，为未来的临床实践和治疗策略提供指导。
