Iizawa H, Ikeda E, Sato T, Ohta Y
Department of Surgery, Yamagata Prefectural Central Hospital, Japan.
Surg Today. 1998;28(11):1168-71. doi: 10.1007/s005950050306.
We report herein the extremely unusual case of a 71-year-old woman with signet-ring cell carcinoma of the ileum. She originally presented with a 6-month history of intermittent nausea and abdominal distention, but initial examinations, including gastrointestinal fiberscopy, ultrasonography, and computed tomography (CT) scan, failed to reveal any cause of her symptoms. A barium-enema study performed 11 months after her initial visit demonstrated a narrow portion of the terminal ileum. An ileocecal resection was subsequently performed, and an epigastric subcutaneous tumor was simultaneously excised. The specimen contained a tumor with a stenotic lumen resembling a "lead pipe", an ulcerative portion, and mucosa with a granular appearance adjoining its proximal site. Many small aphthous lesions with IIa + IIc appearance were seen in the apparently normal mucosa. Histopathological examination confirmed a diagnosis of signet-ring cell carcinoma. The small aphthous lesions seemed to be metastases spread via the lymphatic vessels. Our review of the medical literature revealed three cases of signet-ring cell carcinoma of the jejunum; however, this is the first reported case of signet-ring cell carcinoma of the ileum.
我们在此报告一例极为罕见的71岁女性回肠印戒细胞癌病例。她最初表现为有6个月间歇性恶心和腹胀病史，但包括胃肠纤维内镜检查、超声检查和计算机断层扫描（CT）在内的初步检查均未发现其症状的任何病因。在她初次就诊11个月后进行的钡灌肠检查显示回肠末端有狭窄段。随后进行了回盲部切除术，并同时切除了上腹部皮下肿瘤。标本包含一个管腔狭窄类似“铅管”的肿瘤、一个溃疡部分以及在其近端相邻处有颗粒状外观的黏膜。在看似正常的黏膜中可见许多呈IIa + IIc外观的小阿弗他病变。组织病理学检查确诊为印戒细胞癌。这些小阿弗他病变似乎是通过淋巴管扩散的转移灶。我们对医学文献的回顾发现了3例空肠印戒细胞癌病例；然而，这是首例报告的回肠印戒细胞癌病例。
