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융모상피암종성 분화를 보이는 직장의 선암종

Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation - A case report -

대한대장항문학회지 2007년 23권 4호 p.274 ~ 278
정재홍 ( Jeong Jae-Hong ) - 성균관대학교 의과대학 삼성서울병원 외과학교실

조용범 ( Cho Yong-Beom ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
박치민 ( Park Chi-Min ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
윤해란 ( Yun Hae-Ran ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
이원석 ( Lee Won-Suk ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
서연림 ( Suh Yeon-Lim ) - 성균관대학교 의과대학 삼성서울병원 병리학교실
윤성현 ( Yun Seong-Hyeon ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
이우용 ( Lee Woo-Yong ) - 성균관대학교 의과대학 삼성서울병원 외과학교실
전호경 ( Chun Ho-Kyung ) - 성균관대학교 의과대학 삼성서울병원 외과학교실

Abstract


A choriocarcinoma of the rectum is extremely rare and has a very poor prognosis. Its rarity and the obscurity of its histogenesis make the entity of disease hard to define. We report a case of a choriocarcinoma of the rectum which showed synchronous liver and lung metastasis. A 52-year- old male patient presented with tenesmus, hematochezia and pain on defecation for 4 months. The preoperative colonoscopy revealed a mass at the rectum, 3 cm proximal to the anal verge. The biopsy revealed a poorly differentiated adenocarcinoma. An abdominoperineal resection was performed, and the pathologic examination confirmed a choriocarcinoma arising from an adenocarcinoma. Immunostain for β-human chorionic gonadotropin (hCG) was strongly positive for the choriocarcinoma component. Serum hCG checked postoperatively was as high as 4,222 IU/L, but the serum carcinoembryonic antigen (CEA) was normal. Although chemotherapy was begun at the 5th week after the operation, the patient died on the 47th day after the operation. A choriocarcinoma of the colon or the rectum is very rare and is aggressive. Although radical resection and chemotherapy are performed, the clinical outcome is very disappointing. Even though a choriocarcinoma of the colon or the rectum is very rare, it should be included on the list for differential diagnosis of a colorectal carcinoma. J Korean Soc Coloproctol 2007;23: 274-278

키워드

직장암;선암;융모상피암
Adenocarcinoma;Choriocarcinoma;Rectal cancer
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