Kanesada Kou, Yoshimatsu Kazuhiko, Ito Yoshitomo, Yano Shuya, Hori Masaaki, Higashida Masaharu, Okada Toshimasa, Endo Shunji, Fujiwara Yoshinori, Fujimoto Yasuto, Shiomi Tatsushi, Ueno Tomio
Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan.
Department of Pathology, Kawasaki Medical School, Kurashiki, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):156-161. doi: 10.23922/jarc.2024-054. eCollection 2025.
Colorectal cancer with gut-associated lymphoid tissue (GALT) carcinoma histopathology is particularly rare in very elderly patients. GALT is characterized by submucosal localization and prominent lymphoid infiltration with germinal center formation within tumor-infiltrating lymphocytes. This study aims to report a case of colorectal cancer with GALT carcinoma histopathology in a very elderly patient and to provide a comprehensive literature review. In this case, a 90-year-old female presented with an irregularly elevated tumor in the sigmoid colon, diagnosed via colonoscopy. Computed tomography revealed no lymph node or distant metastases. The patient underwent laparoscopy-assisted sigmoid colon resection with D3 dissection. Histopathological examination revealed well-differentiated adenocarcinoma in the submucosal layer with partial invasion into the muscle layer. Lymphocytes, along with lymph follicles, proliferated compressively in the stroma surrounding the tumor glands. Immunohistochemical analysis showed lost expression of mismatch repair proteins, MLH1 and PMS2, consistent with the tumor immunohistochemistry profile. B cells (CD20- and CD79a-positive) were generally distributed in and around the lymph follicles, while T cells (CD3-positive) were primarily located between the lymph follicles. This case highlights the rare histopathology of GALT carcinoma in colorectal cancer and underscores the importance of considering such diagnoses in elderly patients with colorectal tumors.
具有肠道相关淋巴组织（GALT）癌组织病理学特征的结直肠癌在高龄患者中尤为罕见。GALT的特征是位于黏膜下层，肿瘤浸润淋巴细胞内有生发中心形成，伴有显著的淋巴浸润。本研究旨在报告一例高龄患者的具有GALT癌组织病理学特征的结直肠癌病例，并进行全面的文献综述。在此病例中，一名90岁女性因乙状结肠出现不规则隆起性肿物就诊，经结肠镜检查确诊。计算机断层扫描显示无淋巴结或远处转移。患者接受了腹腔镜辅助乙状结肠切除术及D3淋巴结清扫术。组织病理学检查显示黏膜下层为高分化腺癌，部分侵犯肌层。淋巴细胞与淋巴滤泡一起在肿瘤腺管周围的间质中呈压迫性增殖。免疫组化分析显示错配修复蛋白MLH1和PMS2表达缺失，与肿瘤免疫组化特征相符。B细胞（CD20和CD79a阳性）一般分布于淋巴滤泡内及其周围，而T细胞（CD3阳性）主要位于淋巴滤泡之间。该病例突出了结直肠癌中GALT癌罕见的组织病理学特征，并强调了在老年结直肠肿瘤患者中考虑此类诊断的重要性。
