A CASE REPORT OF VILLOUS TUMOR OF THE RECTUM ASSOCIATED WITH THE ADVANCED SIGMOID CANCER COMPLAINING OF MARKED HYPOKALEMIA AND INCREASE OF MYOGENETIC ENZYME

Abstract

A patient was a 67-year-old man with the complaint of repeated water mucus diarrhea. Laboratory data on admisson showed marked hypokalemia (K 1.7 mEq/1), and increase of myogenetic enzyme associated with hypokalemia. Barium enema examination and colonoscopic examination revealed tumor with velvety mucosa in the rectum and revealed a Yamada type 4 polyp and Borrmann type 3 advanced cancer. Biopsy specimen revealed respectively villous adenoma, tubular adenoma and well differentiated adenocar-cinoma. Resection of the tumors was performed. Resected specimen revealed a large, wide-spread tumor measuring 12 × 10 cm in the rectum. Histological findings showed villous adenoma with cancer cells which invased to the subumucosal layer partially. And it revealed in the sigmoid colon a polyp consisted of tubular adenoma, 1 cm in size and an advanced cancer consisting of well differentiated adenocarcinoma, 3.5 × 4.0 cm in size. A patient had no symptoms after operation, until he had died of a reccurence of sigmoid cancer, 18 months later. Villous tumor with electrolyte depletion syndrome is rare in Japan and only 20 cases have been reported including this case.