Malignant Polyp Post Polypectomy with Unusual Behavior

惡性大腸瘜肉經大腸鏡切除後：併不尋常轉移之病歷報告

陳東源(Tung-Yuan Chen) ； 陳鴻華(Hong-Hwa Chen) ； 金仁(Zen King)

《中華民國大腸直腸外科醫學會雜誌》 18卷1期 (2007/03) Pp. 31-38

https://doi.org/10.6312/SCRSTW.2007.18(1).09613

摘要

大腸鏡廣泛應用於疑大腸病兆的篩檢，大腸瘜肉切除手術及大腸病症術後追蹤。經許多研究證實，大腸瘜肉與癌症有一定的相關，且腫瘤性瘜肉切除亦可降低大腸癌之發生率。至於惡性瘜肉經大腸鏡瘜肉切除手術，若可完全切除再加術後完整追蹤，復發極低，幾可達一定治癒效果（尤其是早期只達黏膜下層，分化良好、無血管淋巴侵犯），許多學說研究亦支持這項論點。報告一例早期惡性大腸瘜肉，經大腸鏡瘜肉完整切除手術併定期大腸鏡追蹤，卻於五年多後，經大腸鏡檢查於原切除病症復發併已肝轉移。經由此少見病例討論惡性瘜肉形成的理論基礎，經由組織學討論癌細胞可能轉移的方式及癌細胞的殊多不確定性，再次強調，惡性瘜肉完整切除雖可達治療效果但仍有可能轉移，如此例早期惡性瘜肉，就如同諺語所說“羊披虎皮”不可等閒視之。

關鍵字

惡性大腸瘜肉

並列摘要

Problems with managing the malignant polyp are likely to be more frequently encountered and controversial. It is generally believed that a polypectomy is sufficient for treatment of a benign polyp or carcinoma in situ. A malignant polyp or early cancer can be treated with polypectomy by endoscopy, but the incidence of the recurrence is about 10-14%. This is via lymph node metastasis, recurring at the original polypectomy site or distant metastasis. Most malignant polyps can be resolved by polypectomy or colectomy following colonscopy if the margin is free of tumor or be resolved by colectomy if the margin may have residual tumor. We report a rare case of malignant peduculated polyp demonstrated by polypectomy with free margin of resection. Pathology revealed the malignant transformation with submucosal invasion. We explained the incidence of recurrence to the patient and suggested colectomy, but he refused surgery and received only regular follow up. A recurrence of cancer at the original polypectomy lesion with lymph node and liver metastasis were noted 5 years later by annual colonscopic follow-up.

並列關鍵字

Malignant polyp