腹股溝疝氣內意外發現轉移性腫瘤-案例報告與文獻探討
潘綱凡、賴昱維
台北市聯合醫院仁愛院區 外科部 泌尿外科
Incidental finding of Metastatic cancer in inguinal hernia sac
Gary K. Pan, Yu-Wei Lai,
Division of Urology, Department of Surgery,
Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
Purpose: Metastatic cancer in hernia was rare and colon cancer incarcerated into an inguinal hernia was even more rare as only 41 cases have been reported since 1938.We presented a case of a 86 year-old man who had right inguinal hernia with poorly differentiated adenocarcinoma in it.
Case presentation: This 86-year-old man suffered from lower abdomen pain accompanied with constipation for one month. He had the history of age-related heart failure symptoms, hyperlipidemia, chronic kidney disease stage 3 and left renal stone and ureteral stone.
Physical exam showed a protruding mass over right inguinal region. Pre-operative survey showed hyponatremia, anemia(hemoglobin,7.2 g/dl).He underwent right hernioplasty and double J stent omission after left ureteroscopic lithotripsy afterwards. However, the pathology of the inguinal hernia showed metastatic adenocarcinoma. The tumor cells show CDX-2, p504S, and CK20 positive. The CK7 and WT-1 are negative for tumor cells. The morphological and immunohistochemical features support the diagnosis of metastatic adenocarcinoma of low gastrointestinal origin. Therefore,he had abdominal CT scan, revealing mild thickening rectum, sigmoid colon and descending colon. Furthermore, gastroscopy showed superficial gastritis and fiber duodenoscopy revealed lumen stenosis with edematous changes around AV 40cm which scope couldn’t pass through. PET scan showed that the origin of metastasis of right inguinal hernia was from descending colon cancer with prominent LNs at the left mesocolon and left para-aortic region.3D-assisted laparoscopic left hemicolectomy was performed and pathology showed descending colon adenocarcinoma, moderately to poorly differentiated. Final pathologic staging was pT4aN1cM1c.Palliative therapy with capercitabine was suggested. To date,he received 3 course of capercitabine.
Conclusion: It’s hard to distinguish normal hernia sac with those with malignancy through its gross appearance, but experts didn’t recommend routine microscopic histopathological examination. However, in all suspicious cases, not only microscopic examination but also fiberoptic sigmoidoscopy were reasonable to make accurate diagnosis due to the coexistence of an inguinal hernia and colonic cancer.