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Multiple Cancer of Rectum Complicating Longstanding Ulcerative Colitis, Report of a Case E. Sakamoto 1 , H. Adachi 1 , A. Torii 1 , H. Ootsuna 2 , T. Muto 3 1Department of Surgery, National Medical Center Hospital 2Department of Pathology, National Medical Center Hospital 3Department of Surgery, Tokyo University Hospital pp.1113-1122
Published Date 1978/8/25
DOI https://doi.org/10.11477/mf.1403107409
  • Abstract
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 A 49-year-old woman visited our hospital with a complaint of severe continuous bloody stools for the past two years. She had undergone left hemicolectomy with transverso-sigmoidostomy for ulcerative colitis 12 years previously, and since then she had been occasionaly treated by oral steroid when she had episodes of diarrhea or bloody stool.

 On admission routine blood test revealed anemia, hypoalbuminemia and marked elevation of serum CEA. Barium enema showed loss of haustra, multiple erosions of the residual colon and stenosis of the rectosigmoid. On colonoscopy the mucosa was reddish and edematous with multiple erosions, but no evidence of carcinoma was detected. Multiple biopsies of the stenotic site revealed poorly differentiated adenocarcinoma with dysplastic or precancerous change of the surrounding mucosa. Proctocolectomy with modified Kock's‘continent ileostomy’was performed. Postoperative course was uneventful.

 Operative specimen showed dark-reddish mucosa with fine granularity of the whole colon. Apart from marked thickening of the bowel wall at the site of stenosis no definite findings suggestive of malignancy were noticed. The whole specimen was examined microscopically by step serial sections of 5 mm width in an attempt to find distribution of cancer and precancerous change of the mucosa. The main tumor was advanced carcinoma of mixed, well and poorly differentiated adenocarcinoma with lymph node metastasis. It was surrounded by wide area of carcinoma with submucosal invasion and carcinoma in-situ. There were multiple foci of carcinoma in-situ and a focus of invasive carcinoma only distal to the main tumor. All the remaining mucosa was convered by irregular tubules with variable degree of dysplasia, suggestive of precancerous change. There were multiple well differentiated, poorly differentiated and signet-ring cell carcinomas present in the surrounding mucosa. There was no active inflammation or normal mucosa in the specimen. This is a typical example of multiple colon cancer complicating ulcerative colitis with a 12-year history and probably the first histologically well described case in this category in Japan.


Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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