A CASE OF PRIMARY DIFFUSE INFILTRATIVE CARCINOMA OF THE RECTUM

Abstract

A 35-year-old woman complained of abdominal pain and constipation. On digital examination, a rectal tumor was palpated and barium enema exmination revealed obvious diffuse stenosis of the rectum. Left leg edema was caused by inguinal lymph node swelling. Histology of the colonoscopy biopsy specimens disclosed poorly differentiated adenocarcinoma. Only sigmoid loop colostomy was performed since the tumor was fixed in the pelvic organs and Virchow lymph node metastasis was already evident. She died of cachexia 34 days after operation. Autopsy revealed diffuse peritoneal dissemination and widespread metastasis to the pelvic and paraaortic lymph nodes. A cancerous wall about 20 cm thick was located from the anus to the colostomy, and invasion was found in the vagina, uterus and urinary bladder. Primary, diffuse, infiltrating type of colorectal cancer has shown a particularly high malignant potential and a bleak prognosis, compared to ordinal carcinoma of the large bowel. Early diagnosis and treatment are therefore desirable for this type of carcinoma.