Lim Jun Kyeong, Kim Suk Bae, Shin Hyun Deok
Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
Korean J Gastroenterol. 2024 Dec 25;84(6):282-287. doi: 10.4166/kjg.2024.091.
A 54-year-old man presented with constipation with a six-month duration and a 5 kg weight loss over 10 months. He had undergone a subtotal gastrectomy and chemotherapy for advanced gastric cancer 13 years earlier. A colonoscopy revealed a firm, circular, in-growing mass in the rectum. A computed tomography (CT) scan showed a 3.0×1.2 cm invasive mass near the prostate, abutting the rectal wall and invading the right ureterovesical junction, causing hydroureteronephrosis. A positron emission tomography-CT scan indicated low fluorodeoxyglucose uptake in the rectal or prostate area. The biopsy results showed poorly differentiated carcinoma. An immunohistochemistry study confirmed CK7 positive, CK20 negative, MUC2 negative, and CDX2 focally positive immune phenotype for cancer cells, suggesting a diagnosis of metastatic adenocarcinoma with a gastric origin rather than a prostate and rectal origin.
一名54岁男性，有6个月的便秘史，10个月内体重减轻5千克。13年前他因晚期胃癌接受了胃大部切除术及化疗。结肠镜检查发现直肠有一个质地硬、圆形、向内生长的肿物。计算机断层扫描（CT）显示前列腺附近有一个3.0×1.2厘米的浸润性肿物，紧贴直肠壁并侵犯右侧输尿管膀胱连接部，导致肾盂积水。正电子发射断层扫描-CT显示直肠或前列腺区域氟脱氧葡萄糖摄取较低。活检结果显示为低分化癌。免疫组化研究证实癌细胞的免疫表型为细胞角蛋白7（CK7）阳性、细胞角蛋白20（CK20）阴性、黏蛋白2（MUC2）阴性、尾型同源盒转录因子2（CDX2）局灶性阳性，提示诊断为胃源性转移性腺癌，而非前列腺和直肠源性。
