尿管溢流で発症，Ｌｙｍｐｈａｎｇｉｏｓｉｓ　Ｃａｒｃｉｎｏｍａｔｏｓａを呈した径６ｍｍ　Ｉｓ直腸癌の１例

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  • A Case of Rectal Cancer with type Is, 6mm-diameter, Mucosal Lesion, Ureteral Spill, and Lymphangiosis Carcinomatosa.

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A case of rectal cancer with abdominal pain caused by ureteral spill and developed lymphangiosis carcinomatosa was reported. The tumor was a type Is, 6 mm-diameter, mucosal lesion with severe lymph duct invasion of the submucosal layer. The patient was a 55-year-old male who visited our hospital, complaining of right abdomenal pain. As a result of exploration, right ureteral spill was diagnosed. Barium enem indicated severe stenosis in the Rs region. Endoscopy indicated an elevated lesion of 10mm-diameter type Is in the Rs region, and subsequently applied EMR revealed moderately differentiated adenocarcinoma with a 6 mm-diameter mucosal lesion, which was accompanied by severe lymph duct invasion of the submucosal layer. The diagnosis of diffuse filtrating rectal cancer was established, and surgery was performed. During surgery, prominent sclerosis of the rectal wall in the region ranging from Rs to Rb was observed, as well as metastasis to the right periureteral lymph node and the abdominal paraaortic lymph node. Chemotherapy and radiotherapy were also given. However, the patient died of recurrence 11 months after surgery. In this case, a mucosal lesion as small as about 6mm, and metastasis into the lymph node in the sm region caused type Is elevated lesion. The invasion of lymph nodes seemed to cause thickness and sclerosis of the rectal wall, and the right metastatic periureteral lymph node caused ureterostenosis and ureteral spill.

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