原発病変から１５ｃｍ離れたこう門管に壁内転移を認めた直腸癌の１例

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  • A CASE OF RECTAL CARCINOMA WITH DISTAL INTRAMURAL SPREAD TO THE ANAL CANAL 15cm DISTANT FROM THE PRIMARY LESION

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We report a rare case of rectal carcinoma with distal intramural spread to the anal canal 15cm distant from the primary lesion.<br> A 61-year-old man underwent a high anterior resection (HAR) of the rectum for rectal carcinoma on February 13, 2003, which was moderately differentiated adenocarcinoma, Rs, type 2, 50×60mm in size, whole-circumferential growth, se, P0, H0, M(-), lyl, v0, n(-), D3, aw(-), ow(-), ew(-), CurA, and Stage II. Colonofiberscopy conducted 10 months after surgery showed a submucorsal tumor 2.0cm in diameter with ulceration in the center of the tumor. Its anal side edge existed on the dentate line in the posterior wall of the anal canal. The pathological findings of biopsy showed adenocarcinoma and metastatic tumor of rectal carcinoma was diagnosed. A Mile's operation was performed to the tumor on January 14, 2004. Histopathological examination showed two tumors, a 25×20mm tumor in the posterior wall of the anal canal and a 15×7mm tumor at the anastomosis 11cm proximal to the anal verge, which were moderately differentiated adenocarcinoma. Histological examination of those two tumors disclosed that they were the same type as the primary carcinoma and were isolated. We thus diagnosed the tumor at the anastomosis as local recurrence and the tumor of anal canal posterior wall as distal intramural spread of the primary rectal carcinoma.

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