Long-standing ulcerative colitis complicating rectal cancer and bile duct carcinoma-report of a case and review of the literature.

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In Japan, ulcerative colitis (UC) complicating colorectal cancer is not as common as in United States and Europe, and so far only 25 cases have been reported in the Japanese literature. It is suggested that patients with UC also have an increased risk of developing carcinoma of the bile duct, but UC complicating colorectal cancer and bile duct carcinoma seems to be a very rare association. This paper presents a rare case of long-standing UC complicating rectal cancer and bile duct carcinoma.<BR>A 68-year-old man with a history of diarrhea over the previous 27 years was admitted with jaundice, epigastric discomfort and hepatomegaly. He had undergone cholecystectomy at another hospital 10 months before admission, but no gallstones had been detected. Physical examination revealed hepatomegaly and a sessile rectal mass on digital investigation. Laboratory studies showed slight liver dydfunction (T-Bil. 1.9 mg/dl, Al-p 430 IU/ml, GPT 77IU/ml) and a positive occult blood test for stools. Barium enema and colonoscopic findings showed very mild active ulcerative colitis with total colon involvement and a flat elevated lesion of the rectum. Biopsy histology confirmed a diagnosis of mild active UC with dysplasia and well-differentiated adenocarcinoma.<BR>Percutaneous transhepatic cholaniography demonstrated a dilated intrahepatic bile duct with filling defect, suggesting a diagnosis of intrahepatic stones. Right hepatic lobe'ctomy and transanal local excision of the rectal tumor were performed. Histological findings revealed papillotubular adenocarcinoma of the intrahepatic bile duct with pericholangitis and a welldifferentiated adenocarcinoma of the rectum, 1.5×1.0 cm in diameter, with marked inflammatory cell infiltration. The patient died of recurrence of bile duct cancer three years after discharge. Cases of UC complicating colorectal cancer and bile duct carcinoma reported in Japan were also reviewed.
日本大腸肛門病学会の論文

Long-standing ulcerative colitis complicating rectal cancer and bile duct carcinoma-report of a case and review of the literature.

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