Kitasaki Nao, Kochi Masatoshi, Teshima Marino, Nakagawa Masataka, Toyota Kazuhiro
Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center, 739-0041, 513, Jike, Saijocho, Higashihiroshima, Hiroshima, Japan.
Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center, 739-0041, 513, Jike, Saijocho, Higashihiroshima, Hiroshima, Japan.
Int J Surg Case Rep. 2024 Dec;125:110643. doi: 10.1016/j.ijscr.2024.110643. Epub 2024 Nov 25.
Spindle cell sarcoma (SCS) is a sarcoma subtype rarely described in the abdominal cavity, and with a worse prognosis compared with that at other sites. We report a case of SCS occurring at the anastomosis after ileal resection for colorectal cancer.
An 86-year-old woman with a chief complaint of abdominal pain had undergone ileal resection, D2 dissection, and hand-sewn anastomosis in 2011 to treat papillary stage I adenocarcinoma. In February 2023, the patient was referred to our hospital because of progressive anemia, and a full circumferential type 3 tumor was found at the anastomosis site after resection of the ascending colon. Biopsy revealed a malignant spindle tumor. The patient underwent an open right hemicolectomy of the colon and limited lymph node dissection. The final pathological examination revealed an undifferentiated SCS centered on the anastomosis. Postoperative follow-up imaging is ongoing, and there has been no recurrence.
SCSs are a group of tumors composed of spindle-shaped cells. Diagnosis based solely on morphology is difficult. The final diagnosis was based on the results of immunostaining and genetic testing. A diagnosis of sarcomatous transformation due to local recurrence was ruled out. Since the possibility of a dedifferentiated liposarcoma remained, a definitive diagnosis of undifferentiated SCS with an undetermined differentiation direction was not confirmed.
SCS is a rare disease, and this is the first reported case of SCS occurring in the colon or during colonic anastomosis. Additional cases are necessary to determine an appropriate treatment strategy.
梭形细胞肉瘤（SCS）是一种肉瘤亚型，在腹腔中很少见，与其他部位的梭形细胞肉瘤相比，预后更差。我们报告一例发生在结肠癌回肠切除术后吻合口处的SCS病例。
一名86岁女性，以腹痛为主诉，于2011年接受了回肠切除术、D2淋巴结清扫术和手工缝合吻合术，以治疗乳头状I期腺癌。2023年2月，患者因进行性贫血转诊至我院，在升结肠切除术后的吻合口处发现一个全周型3级肿瘤。活检显示为恶性梭形肿瘤。患者接受了结肠右半结肠根治性切除术及有限淋巴结清扫术。最终病理检查显示以吻合口为中心的未分化SCS。术后随访影像学检查正在进行中，目前尚无复发。
SCS是一组由梭形细胞组成的肿瘤。仅根据形态学进行诊断很困难。最终诊断基于免疫染色和基因检测结果。排除了因局部复发导致肉瘤样转化的诊断。由于仍存在去分化脂肪肉瘤的可能性，因此未确诊为分化方向未明的未分化SCS。
SCS是一种罕见疾病，这是首例报道的发生在结肠或结肠吻合术中的SCS病例。需要更多病例来确定合适的治疗策略。
