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Report of One Case of Carcinoma of the Rectum Associated with Crohn's Disease Like Lesion T. Oohara 1 , A. Ogino 1 , K. Saji 1 , N. Mohri 2 , T. Imamura 2 1The Third Department of Surgery, Faculty of Medicine, University of Tokyo 2Department of Central Clinical Inspection, Faculty of Medicine, University of Tokyo Branch Hospital pp.1683-1687
Published Date 1978/12/25
DOI https://doi.org/10.11477/mf.1403107577
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 The patient was a 52-year-old man with a chief complaint of anal bleeding and dyschezia from three months before. At intrarectal digital examination, totally circumscribed protruding tumor was palpable at about five cm distance from the anal ring and index finger could not pass through. The presence of anal fistula was noted. Roentgenographic examination by use of enema revealed high degree of obstruction for a distance of 5 to 10 cm from the anus. Endoscopically, the tumor was easily bled. By biopsy, it was confirmed to be adenocarcinoma papillotubulare.

 Examination of resected specimen showed a protruding tumor of 4.5×3.5×0.8 cm in size situated at a distance of five cm from the anus. Within the region 5 cm oral to 0.5 cm anal from the tumor, foldings showed irregular elevations, giving an impression of submucosal scirrhous infiltration of the carcinoma. Histologically, the tumor was shown to be adenocarcinoma papillotubulare with depth of pm. Although elevated foldings chiefly situated in the oral side of the tumor exhibited all the characteristic features of Crohn's disease such as inflammatory changes extending throughout the entire thickness of colonic wall especially submucosal abscess, the presence of a number of non-caseous sarcoid-like granuloma and also the presence of fissures in small numbers, this lesion should be interpreted as follows: namely, in carcinoma of the rectum intralesional fissuring occurs at first, which provides causes for development of extensive inflammatory processes and formation of abscesses below submucosal layers of the oral side of the tumor with inflammation extending entire thickness of colonic wall. As a nonspecific response to these processes, a number of granuloma are produced. Therefore, this case is considered to give suggestions on nonspecific establishment of inflammation of entire thickness, granuloma and fissures.


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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