Abstract
A 62-year-old woman was admitted to the hospital because of a fist-sized tumor incarcerating and prolasping from the anus. There was a history of prolapse of the rectum which was found one year before, and she was diagnosed as rectal prolapse at a nearby hospital. This time, the incarcerated tumor was able to be reduced under saddle block. It was a soft and whole-circumferent tumor of the rectum (Rb), with ulceration partially. A diagnosis of villous adenoma of the rectum with infiltrating carcinoma was made. An abdominoperineal excision of the rectum was carrued out. Histopathologically it was a 9×7 cm villous adenoma, and well differentiated adenocarcinoma with the invasion depth of sm was found in the ulcerated lesion. Pararectal lymph nodes were positive for metastasis.
Villous adenoma is an uncommon disease in Japan, but recently reports are increasingly seen in the literature. The disease often manifests bleeding from the anus, diarrhea, and mucous stool. It is associated with prolapse of the tumor in a relatively high frequency, however, incarcerated one is rarely seen. Problems in the treatment of the disease would lie in the high occurrence of cancer change and selection of operative procedure. If some findings such as induration and ulcer suggestive of infiltrating carcinoma are observed, and histological carcinoma is demonstrated, radical operation with lymph node dissection should be selected from the first.
