Wimmer A P, Bouffard J P, Storms P R, Pilcher J A, Liang C Y, DeGuide J J
Department of Medicine, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex 78236, USA.
South Med J. 1998 Dec;91(12):1173-6. doi: 10.1097/00007611-199812000-00017.
Colon cancer typically arises in the colonic lumen, allowing for endoscopic detection of cancerous and premalignant lesions. In the case presented, a 73-year-old man with iron deficiency anemia had two colonoscopies showing only diverticula and internal hemorrhoids. Three years later, when the patient complained of dull, intermittent lower abdominal pain, a third colonoscopy identified diverticula, three adenomatous polyps, and no other abnormality. Computed tomography (CT) of the abdomen revealed a 5 cm x 6 cm pericolic fluid collection, which was later found to communicate with the sigmoid colon. The surgical specimen from a partial colectomy contained a distal sigmoid perforation with a 2.5 cm moderately differentiated adenocarcinoma in the underlying submucosal tissue. There was no gross intraluminal tumor. Histopathology, including immunohistochemistry, was consistent with colonic adenocarcinoma. Primary colon cancer grossly sparing the mucosa is an unusual presentation for this common malignancy.
结肠癌通常起源于结肠腔，这使得内镜能够检测到癌性和癌前病变。在本病例中，一名患有缺铁性贫血的73岁男性接受了两次结肠镜检查，结果仅显示有憩室和内痔。三年后，当患者主诉下腹部钝痛且呈间歇性时，第三次结肠镜检查发现了憩室、三个腺瘤性息肉，未发现其他异常。腹部计算机断层扫描（CT）显示结肠周围有一个5厘米×6厘米的液体积聚，后来发现其与乙状结肠相通。部分结肠切除术的手术标本包含乙状结肠远端穿孔，其下方黏膜下组织中有一个2.5厘米的中度分化腺癌。腔内未见肉眼可见的肿瘤。组织病理学检查，包括免疫组织化学检查，结果与结肠腺癌一致。原发性结肠癌在大体上未累及黏膜，对于这种常见的恶性肿瘤来说是一种不寻常的表现。
