A Case of Villous Tumor of the Rectum with Adenoacanthoma Invaded to the Submucosal Layer Followed by Fuluminant Course by Liver Matastasis

Katsuyuki Kunieda, Shigetoyo Saji, Syuntaro Honda, Akihiko Yoshida, Kyoshi Tsuji, Yasuyuki Sugiyama, Takao Umemoto, Daizo Fukada, Kiichi Miya, Kuniyasu Shimokawa*

Second Department of Surgery, Department of Laboratory Medicine, Gifu Universitv School of Medicine*

We reported a very rare case of villous tumor of the rectum with adenoacanthoma invaded to the submucosal layer. The patient showed a fuluminant course with liver metastasis. A 75-year-old woman consulted a doctor with the chief complaint of anal bleeding, and a rectal tumor was pointed out. She was diagnosed as having rectal villous tumor with cancer invaded to the submucosal layer, and underwent local resection of the tumor by sacral approach after informed consent had been obtained. The tumor was flat in shape and 95×88 mm in size. In histological study, the tumor was mainly well differentiated adenocarcinoma with invasion to the mucosal layer, and showed adenoacanthoma and poorly differentiated adenocarcinoma with invasion to the submucosal layer to the extent of 7 mm. It also showed regional lymphnode metastasis of poorly differentiated adenocarcinoma. After her refusal to undergo re-operation, local recurrence with severe pain and liver metastasis were found 7 months following the first operation, and she underwent posterior pelvic exenteration. The histology of the recurrent foci showed adenoacanthoma. Her condition deteriorated with progressive cancer enlargement, and she died one year after the first operation. It should be taken into consideration that some of rectal villous tumors show fuluminant course, though local resection is thought to be polular treatment for them.

Key words
villous tumor of the rectum, adenoacanthoma, poorly differentiated adenocarcinoma

Reprint requests
Katsuyuki Kunieda The Second Department of Surgery, Gifu University School of Medicine
40 Tsukasa-machi, Gifu-city, 500 JAPAN

Accepted
May 17, 1995

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