Possible associations of rectal carcinoma with Schistosoma japonicum infection and membranous nephropathy:: a case report with a review
Possible associations of rectal carcinoma with Schistosoma japonicum infection and membranous nephropathy:: a case report with a review
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DOI：
10.1093/jjco/29.11.576
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发表时间：
1999-11-01
影响因子：
2.4
通讯作者：
Kojima, S
中科院分区：
文献类型：
--
作者：
Matsuda, K;Masaki, T;Kojima, S
我们报告首例直肠癌合并日本血吸虫和膜性肾病。一名57岁的日本男子注意到他的粪便变窄了。他曾住在山梨县，这是日本血吸虫病的流行地区。他患有肾病综合征约一年。钡灌肠检查显示直肠上部有严重狭窄，肿瘤活检标本显示为分化良好的腺癌和许多日本血吸虫卵子。超声显示肝脏呈网状和线状高回声区，前低位切除并切开活检肝和右肾。组织病理学表现为高分化腺癌和血吸虫卵。切除结肠内总卵数为15133个，其中癌内2243个，癌外12890个。离癌越近，卵子密度越高。肾活检标本光镜和电子显微镜检查结果与膜性肾病(II期)相一致，提示血吸虫卵在致癌和肾病综合征中有一定作用。不明原因肾病综合征患者，尤其是日本血吸虫流行区居民，应排除胃肠道恶性肿瘤为病因。乙状结肠镜检查有助于监测日本血吸虫患者的结直肠癌。
We report the first case of rectal carcinoma associated with S. japonicum and membranous nephropathy. A 57-year-old Japanese man noticed narrowing of his feces. He had lived in Yamanashi prefecture, an endemic area of S. japonicum. He had suffered from nephrotic syndrome for about 1 year. Barium enema study showed a severe stricture in the upper rectum and biopsy specimens from the tumor demonstrated well differentiated adenocarcinoma and many ova of S. japonicum. Sonography of the liver showed a network pattern and a linear high echoic area, Low anterior resection with incisional biopsy of the liver and the right kidney was performed. Histopathological findings showed well differentiated adenocarcinoma and schistosomal ova. The total number of ova in the resected colon amounted to 15 133, consisting of 2243 inside and 12 890 outside the carcinoma. The nearer to the carcinoma the area was, the higher was the density of ova. The findings of light microscopy and electron microscopy of the biopsy specimen from the kidney were compatible with membranous nephropathy (stage II), This case suggests that schistosomal ova have some effect on carcinogenesis and nephrotic syndrome. In patients with nephrotic syndrome of unknown cause, especially in inhabitants of endemic areas of S. japonicum, gastrointestinal malignancy should be ruled out as an etiological factor. Sigmoidoscopy would be useful for colorectal carcinoma surveillance in S. japonicum patients.