A Case of Heterochronous Ascending Colon Carcinoid 7 Years after Curative Resection of Descending Colon Carcinoid

Masaya Nomura, Shigeo Souda, Yoshifumi Inoue, Yukinobu Yoshikawa, Yuichi Fumimoto and Hirohiko Yokotani

Department of Surgery, Nissay Hospital, Nippon Life Saiseikai Foundation

A 53-year-old woman with diarrhea and lower abdominal pain was found in barium enema and colonofiberscopy to have a tumor of the descending colon. Left colectomy (D₂) was done on August 4, 1995. Histopathologically, the tumor was diagnosed as carcinoid and classified as mixed, composed of nonargentaffin, nonargyrophil endocrine cells. The pathological staging was IIIa [mp, n₁ (+)]. Colonofiberscopy 7 years after surgery showed a tumor of the ascending colon. Under the suspicion of carcinoid tumor, right colectomy (D₂) was done on March 19, 2002. Histopathological examination identified the lesion as argyrophil carcinoid (mixed), with a pathological staging of II [ss, n(−)]. Carcinoid tumor of the large intestine, excluding the appendix and rectum, is relatively rare in Japan. That having multiple lesions has been reported in only 3 cases in Japan including ours. Our case is the first of heterochronous colon carcinoid after curative surgery for colon carcinoid. This case suggests that the Wilms' tumor gene (WT1) may be involved in the development of carcinoid tumor of the colon, because WT1 messenger RNA was approximately 200 times higher in the carcinoid tumor specimen than in normal colon tissue.

Key words
carcinoid tumor of colon, heterochronous recurrence, WT1

Reprint requests
Masaya Nomura Department of Surgery, Nissay Hospital, Nippon Life Saiseikai Foundation
6-3-8 Itachibori, Nishi-ku, Osaka, 550-0012 JAPAN

Accepted
September 24, 2003

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