A case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.
A case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.
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DOI：
10.1016/j.ijscr.2014.10.034
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发表时间：
2014
影响因子：
0.6
通讯作者：
Sakamoto, Kazuhiro
中科院分区：
文献类型：
--
作者：
Okazawa, Yu;Takahashi, Rina;Mizukoshi, Kosuke;Takehara, Kazuhiro;Ishiyama, Shun;Sugimoto, Kiichi;Takahashi, Makoto;Kojima, Yutaka;Goto, Michitoshi;Okuzawa, Atsushi;Tomiki, Yuichi;Yao, Takashi;Sakamoto, Kazuhiro
子宫内膜异位症引起的透明细胞腺癌是非常罕见的。子宫内膜异位症恶变的术前诊断非常困难。患者在诊断为直肠癌的情况下接受了低位前切除术。Sampson标准有助于子宫内膜异位症恶变的诊断。子宫内膜异位症恶变预后差。发生在卵巢外的肠型子宫内膜异位症恶变是非常罕见的。我们报告一个非常罕见的情况下，透明细胞腺癌所产生的子宫内膜异位症的直肠。一位83岁的女性因便血入院。结肠镜检查发现一个肿瘤，大约占直肠周长的一半。肿瘤活检显示为高分化腺癌。在诊断为直肠癌的情况下，行腹腔镜下低位前切除术。组织学检查发现透明细胞腺癌，侵犯直肠浆膜下，但没有淋巴结转移。免疫组化染色显示细胞角蛋白7强阳性，而细胞角蛋白20和CDX 2不染色。肿瘤邻近子宫内膜腺体，雌激素受体染色阳性。最终，患者被诊断为子宫内膜异位症引起的透明细胞腺癌。手术后18个月，没有肿瘤复发的迹象。包括我们的病例在内，共报告了7例由肠内异症引起的透明细胞腺癌。由于子宫内膜异位症恶变后的预后仍然很差，因此需要仔细观察。我们报告一个非常罕见的情况下，透明细胞腺癌所产生的子宫内膜异位症的直肠腹腔镜手术治疗。
Clear cell adenocarcinoma arising from endometriosis is very rare. Preoperative diagnosis of the malignant transformation in endometriosis is very difficult. The patient was undergone low anterior resection under the diagnosis of rectal carcinoma. Sampson's criteria are useful for diagnosis of the malignant transformation in endometriosis. The prognosis of malignant transformation in endometriosis is poor. Malignant transformation of intestinal endometriosis occurring in the extraovarian sites is extremely rare. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum. An 83-year-old woman was admitted with the complaint of hematochezia. Colonoscopy revealed a tumor around about half of the rectal circumference. Biopsy of the tumor revealed a well-differentiated adenocarcinoma. Low anterior resection was undergone laparoscopically under the diagnosis of rectal carcinoma. Histopathological examination revealed clear cell adenocarcinoma, invading the sub-serosa of the rectum, but no metastasis of the lymph nodes. Immunohistochemical staining showed strong positivity for cytokeratin 7, but no staining for cytokeratin 20 and CDX2. The tumor existed adjacent to the endometrial glands, which were stained positive for Estrogen receptor. Ultimately, the patient was diagnosed with clear cell adenocarcinoma arising from endometriosis. Eighteen months after surgery, there are no signs of tumor recurrence. Clear cell adenocarcinoma arising from intestinal endometriosis has been reported in 7 cases, including our case. Careful observation is required because the prognosis of endometriosis after malignant transformation remains poor. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.