Colonic adenocarcinomaに発生したcolonic moruleの一例

Abstract

We report a case of colonic morules with colonic adenocarcinoma. A 69-year-old woman visited our hospital with the complaint of abdominal pain. The examination showed lower abdominal tenderness and muscular guarding. Ultrasonogra- phy and computed tomograpy showed inflanunatory change in the ileocecal region with cecal diverticula and presence of ascites. Surgical therapy was performed under a diagnosis of cecal perforation. The surgery revealed a cecal tumor which had ruptured. Iliocecal resection combined with lymph nodes dissection (D2) and peritoneal lavage was performed. Histopathological examination revealed that the cecal tumor showed well- differentiated adenocarcinoma with morular structures composed of small, oval cells with bland nuclei in a mulberry-like arrangement. On immunohistochemical examination, the morule showed nuclear overexpression of β catenin and CDX2, cytoplasmic overexpression of CD10, and no expression of cytokeratin 20. Correct pathological diagnosis is important to avoid an erroneous diagnosis of adenosquamous carcinoma because morules morphologically bear a striking resemblance to squamous metaplasia but are morphologically and qualitatively quite different from squamous metaplasia. She has survived for 1.5 years since the operation, and shows good QOL under the follow-up.