Clinical Endoscopy

  • 제41권6호
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  • Pages.373-377
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

원발성 대장 반지세포암종의 직장 전이 1예

A Case of Rectal Metastasis from Primary Signet Ring Cell Carcinoma of the Colon

  • 백관미 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 차재명 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 이정일 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 주광로 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 신현필 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 박재준 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 전정원 (경희대학교 의과대학 강동경희대학교병원 내과학교실) ;
  • 김교영 (경희대학교 의과대학 강동경희대학교병원 병리학교실)
  • Pack, Kwan-Mi (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Cha, Jae-Myung (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Lee, Joung-Il (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Joo, Kwang-Ro (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Shin, Hyun-Phil (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Park, Jae-Jun (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Jeon, Jung-Won (Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Kim, Gou-Young (Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine)
  • 투고 : 2010.05.26
  • 심사 : 2010.08.18
  • 발행 : 2010.12.30
⟨ 이전 논문 다음 논문 ⟩

초록

대장암의 직장전이가 복막전이 없이 발생하는 경우는 매우 드물며, 이런 경우 초기 임상양상이 단순 염증과 감별이 어려울 수 있다. 저자들이 확인한 바에 의하면, 대장암의 직장전이 증례는 보고되지 않았다. 45세 남자 환자가 3주간 지속된 변비와 복통을 주소로 내원하였다. 과거력에서 4년 전 하행결장의 원발성 반지세포암종으로 좌측 결장반절제술 및 보조 항암화학요법을 받았다. 대장내시경 검사에서 수술 문합부의 재발 소견은 없었지만, 하부 직장 내강이 좁아져 있었고, 점막의 요철이 단단하게 관찰되었다. 조직 생검에서는 만성 염증 소견만 보였다. 양전자방출단층촬영에서도 경도의 미만성 섭취가 직장에서 관찰되어 단순 염증을 시사하였다. 자기공명영상에서는 직장점막하층 벽의 비후와 다발성 직장 주위 림프절이 관찰되었다. 임상적으로 대장암의 직장전이로 재발이 의심되었기 때문에 수술적 전층 절제 조직에서 반지세포암종으로 확진한 후 복회음 절제술을 시행하였다.

Rectal metastasis of colon cancer without peritoneal carcinomatosis is a rare condition whose initial clinical presentation may mimic inflammation. To the best of our knowledge, there was no report on such cases. A 45-year-old man with a history of left hemicolectomy and adjuvant chemotherapy for primary signet ring cell carcinoma (SRCC) of the descending colon, admitted to have constipation and abdominal pain for 3 weeks. His colonoscopic findings did not show local tumor recurrence at the anastomsis site, however, a hard, concentric luminal narrowing of the lower rectum was encountered. Endoscopic biopsies revealed chronic inflammations, and positron emission tomography with $^{18}F$-fluorodeoxyglucose revealed diffuse mildly hypermetabolic lesion in the rectum, suggesting inflammation. Magnetic resonance image showed submucosal wall thickening with multiple perirectal lymph nodes. Rectal metastasis of colon cancer was highly suspected clinically and a surgical biopsy confirmed SRCC which was surgically removed thereafter.

키워드

참고문헌

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