상행성 결장에 발생한 편평상피암의 1예
A Case of Squamous Cell Carcinoma of the Ascending Colon
부산의대잡지 1973년 13권 2호 p.133 ~ 137
김경택, 박봉윤, 임귀순, 김순호, 박수연,
소속 상세정보
김경택 ( )
부산대학교 의과대학 병리학교실
박봉윤 ( )
부산대학교 의과대학 병리학교실
임귀순 ( )
부산대학교 의과대학 병리학교실
김순호 ( )
부산대학교 의과대학 병리학교실
박수연 ( )
부산시립병원 외과
KMID : 0365819730130020133
Abstract
저자들은 위에서 54세의 한국인 남자의 상행성 결장에 발생한 편평상피암의 1예를 보고하는 동시에 이런 종양에 관한 약간의 문헌적 고찰을 하였다.
이 증예는 저자들이 아는한 한국에서 처음으로 보고되는 상행성 결장의 편평상피암이다.
A case of squamous cell carcinoma of the ascending colon is to be reported and a review of literature related to this case is presented in the aspect of history, histogenesis and histopathology. This would be the first of such case found in Korea.
A 53 year-old Korean man was admitted to the department of surgery in Busan City Hospital in November, 1973, because of severe pain and tumor in the right lower abdomen. About five months before admission, he had general weakness and weight loss and he feeled quite exhoused. About three months before admission, he had occasionally intermittent abdominal pain and distress, but he made no complaints such as vomiting, diarrhea and fever. About ten days before admission, he complained of more severe intermittent abdominal pain and accidentally noticed a child fist-sized, movable tumorous mass in the right lower abdomen. However, there were no constipation, intestinal hemorrhage and lumbar pain.
On physical examintion at admission, the patient appeared poor in nutrition. The temperature was 36.7°C, the pulse 72, and the respiration 20. The blood pressure was 110/70. There was no icterus and anemia in conjunctiva of the eyes. There was no lymphadenopathy. The examination of the chest was negative. A child fist-sized, mobile, hard mass was palpated in the right lower quadrant of the abdomen. An x-ray film of the chest was normal. An x-ray examination of the abdomen revealed an union of the old fracture in T1= L1 vertebrae. Examination by anal barium enema revealed a filling defect with mucosal destruction at the mid-portion of the ascending colon. The proximal part of the ascending colon was not observed. The radiologist suggested a cancer of the ascending colon. The examination of the peripheral blood and urine were within normal limits. The rectal examination was negative. A hemicolectomy of the ascending colon was performed under the clinical diagnosis of colon cancer. The operative findings revealed no gross metastatic lesions. The resected ascending colon was sent to the department of clinical pathology, Pusan National University to be examined morphologically.
Grossly, the ascending colon measured about 9 cm in length. The surface was somewhat hyperemic. On sectioning the colon, there was noted a fungating mass arising from its mucosa. The mass measured about 4.5cm in wideness and about 1 cm in hight and situated just above the ileocecal valve, extending to about 10cm above it. The tumor appeared gray in color and firm in consistency and its surface was superficially ulcerated. The adjacent mucosa was extensively edematous. The lymph nodes around the colon had undergone moderate swelling. A section through the tumor revealed the subserosal layer involved in the tumorous process.
Histologically, the sections from the margin of the tumor showed columns and masses of atypical epithelial cells, separated by a small amounts of hyalinized connective tissue. The neoplastic cells extended through the submucosa and the muscular layer to the subserosal layer. The most neoplastic cells were large, polygonal and moderately pleomorphic, having hyperchromatic nuclei with marked keratinization, while some of them were rather small, having hypochromatic nuclei in pale granular cytoplasm. In - most of the neoplastic masses there were noted cancer pearls and occasionally intercellular bridges between the prickle cells. In the adjacent mucosa of the neoplasm, there were some glands filled with neoplastic polygonal cells, a feature suggesting that this tumor might originate from the glandular epithelium.
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