A Case of Circumferential Adenomas of the Rectum with Coexisting Adenocarcinoma N. Murayama 1 , S. Morioka 1 , O. Abe 1 , S. Baba 2 1Department of Surgery, School of Medicine, Keio University 2Second Department of Surgery, Hamamatsu Medical School pp.555-559
Published Date 1978/4/25
DOI https://doi.org/10.11477/mf.1403107299
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 A sixty-nine-year old woman, who had been suffering from constipation and diarrhea for the past eight years, was seen by a doctor in August 1974 for radiological examination. She was referred to our service in October 1974. Diagnosis was rectal cancer as confirmed by K-ray and proctoscopical examinations. The patient was submitted to Miles operation with regional lymph node dissection.

 Macroscopic observation of the lesion in the resected specimen was featured by an apparent advanced cancer in the midst of adenomas, which circumferentially extended 7 cm long along the rectum. Histologically adenocarcinoma muconodullare was observed in the midst of wide-spread adenomas.

 The circumferential adenoma mostly showed tubular pattern.

 Villous pattern was observed only in the adjacent area encircling the carcinoma in the center.

 This case is characterestic of having an extensive lesion of both cancer and adenomas together with the transional zonation from tubular adenoma through villous pattern to adenocarcinoma.

 The finding can hardly be explained by Collision Theory, in which adenomas and carcinoma co-existing in different portions of the rectum are said to fuse each other. This case may suggest the possibility of transformation of tubular adenoma to adenocarcinoma through villous pattern adenomas. Histochemically alkaline phosphatase activity was not detected in adenomas. However, it was positive in brush border of the cancer cells. Its significance remains to be studied in terms of intestinal metaplasia of the colon and rectum.

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