Onoyama Haruna, Kojima Shigehiro, Ahiko Yuka, Sakuyama Naoki, Monma Satoko, Aikou Susumu, Ota Yasunori, Shida Dai
Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Pathology, The Institute of Medical Science Research Hospital, The University of Tokyo, Tokyo, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):423-427. doi: 10.23922/jarc.2024-037. eCollection 2024.
Although colorectal cancer frequently invades adjacent organs, colon-to-colon invasion is rarely observed, and colo-colonic fistula formation due to colorectal cancer is uncommon. Here we report a case of preoperative diagnosis of cecal cancer that has invaded the transverse colon. A 69-year-old woman presented with diarrhea and a palpable mass in the lower right abdomen. After being diagnosed with double cancer involving the cecum and transverse colon at a previous hospital, she was referred to our hospital. CT scans revealed enhanced mass-like wall thickening in both the cecum and transverse colon, with 3D-CT suggesting a cecal tumor invading the transverse colon. The accurate preoperative diagnosis and prediction of fistula formation led us to perform curative resection using laparoscopic surgery. The resected specimen contained an ulcerated moderately differentiated adenocarcinoma measuring 6.0 cm × 4.5 cm in the cecum. Additionally, a fistula originating from the cecal cancer and communicating with the transverse colon was identified. The tumor was classified as stage IIIC (T4b, N1, M0). When multiple masses are identified in the colon, it is important to consider the possibility of the primary tumor invading neighboring organs and the potential for fistula formation.
尽管结直肠癌常侵犯邻近器官，但结肠到结肠的侵犯很少见，且结直肠癌导致的结肠结肠瘘形成并不常见。在此，我们报告一例术前诊断为侵犯横结肠的盲肠癌病例。一名69岁女性因腹泻及右下腹部可触及肿块就诊。在之前的医院被诊断为同时累及盲肠和横结肠的双癌后，她被转诊至我院。CT扫描显示盲肠和横结肠均有强化的肿块样壁增厚，三维CT提示盲肠肿瘤侵犯横结肠。术前的准确诊断及对瘘形成的预测使我们采用腹腔镜手术进行了根治性切除。切除标本中，盲肠有一个6.0 cm×4.5 cm的溃疡型中分化腺癌。此外，还发现了一个起源于盲肠癌并与横结肠相通的瘘。肿瘤被分类为IIIC期（T4b，N1，M0）。当在结肠发现多个肿块时，重要的是要考虑原发性肿瘤侵犯邻近器官的可能性以及形成瘘的可能性。
