粘膜下層浸潤部に腺へん平上皮癌の組織像を呈し，急速な経過をたどった直腸じゅう毛腫ようの１例

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  • A Case of Villous Tumor of the Rectum with Adenoacanthoma Invaded to the Submucosal Layer Followed by Fuluminant Course by Liver Matastasis.

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We reported a very rare case of villous tumor of the rectum with adenoacanthoma invaded to the submucosal layer. The patient showed a fuluminant course with liver metastasis. A 75-year-old woman consulted a doctor with the chief complaint of anal bleeding, and a rectal tumor was pointed out. She was diagnosed as having rectal villous tumor with cancer invaded to the submucosal layer, and underwent local resection of the tumor by sacral approach after informed consent had been obtained. The tumor was flat in shape and 95×88mm in size. In histological study, the tumor was mainly well differentiated adenocarcinoma with invasion to the mucosal layer, and showed adenoacanthoma and poorly differentiated adenocarcinoma with invasion to the submucosal layer to the extent of 7mm. It also showed regional lymphnode metastasis of poorly differentiated adenocarcinoma. After her refusal to undergo re-operation, local recurrence with severe pain and liver metastasis were found 7 months following the first operation, and she underwent posterior pelvic exenteration. The histology of the recurrent foci showed adenoacanthoma. Her condition deteriorated with progressive cancer enlargement, and she died one year after the first operation. It should be taken into consideration that some of rectal villous tumors show fuluminant course, though local resection is thought to be polular treatment for them.

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