子宮留膿腫と癒着していたため深達度診断が困難であったＳ状結腸癌の１例

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  • A CASE OF SIGMOID COLON CANCER ASSOCIATED WITH PYOMETRA IN WHICH THE STAGE OF INVASION WAS DIFFICULT TO DIAGNOSE BECAUSE OF ADHESION

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This paper describes a case of sigmoid colon cancer associated with pyometra in which the stage of cancer invasion was difficult to diagnose because of the presence of adhesions caused by the pyometra. An 88-year-old woman was seen at our hospital because of a lower abdominal pain and was later admitted with a diagnosis of sigmoid colon cancer based on the results of a colonofiberscopic study. On admission, she exhibited mild ileus symptoms that were relieved by the insertion of a nasogastric tube and the administration of fluids. An abdominal CT scan revealed that the sigmoid colon cancer had invaded the uterus, and a sigmoidectomy with excision of the uterine supports was performed. A postoperative histopathological study showed that the adhesions were not from cancer invasion but were, in fact, inflammatory adhesions.<br>Eight cases of pyometra concomitant with cancer of the sigmoid colon or rectum have been reported to date, including the present case. Of these eight cases, only two cases did not have tumor invasion into the uterus. Cancer is thought to rarely infiltrate the lumen of the uterus due to the thick uterine wall. However, differentiating between the direct invasion of a neoplasm and inflammatory infiltration is difficult if the cancer is associated with pyometra; consequently, the stage of invasion is often mis-diagnosed prior to surgery.

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