Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Rectal Leiomyosarcoma Presenting as a Semipedunculated Polypoid Mass

반유경성 용종 형태를 보인 직장 평활근육종 1예

  • Lee, Sang-Heon (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Ji-Hyun (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine) ;
  • Seo, Jeong-Ah (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine) ;
  • Moon, Sung-Soo (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine) ;
  • Kang, Hyoun-Gu (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine) ;
  • Seol, Sang-Young (Department of Internal Medicine, Pusan Paik Hospital, Inje University College of Medicine)
  • 이상헌 (인제대학교 의과대학 부산백병원 내과학교실) ;
  • 김지현 (인제대학교 의과대학 부산백병원 내과학교실) ;
  • 서정아 (인제대학교 의과대학 부산백병원 내과학교실) ;
  • 문성수 (인제대학교 의과대학 부산백병원 내과학교실) ;
  • 강현구 (인제대학교 의과대학 부산백병원 내과학교실) ;
  • 설상영 (인제대학교 의과대학 부산백병원 내과학교실)
  • Received : 2010.03.11
  • Accepted : 2010.05.11
  • Published : 2010.08.30
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Abstract

Rectal leiomyosarcoma is an extremely rare disease. Anal bleeding, rectal pain and a sensation of pressure in the anus are the most common symptoms. It tends to form a polypoid intraluminal mass and commonly originates from the muscularis propria, but may arise from the muscularis mucosa, or in the walls of the blood vessels. Characteristically, leiomyosarcoma has very high mitotic activity and is, on immunohistochemical staining, positive for actin and desmin, but negative for c-kit and S-100. We experienced a case of a rectal leiomyosarcoma in a 54 year-old man who presented with anal bleeding. Colonoscopic examination revealed a 4.5 cm-sized semipedunculated polypoid mass at mid-rectum. We confirmed that it was a leiomyosarcoma histologically by endoscopic resection with mechanical snaring. Low anterior resection followed by radiation therapy was performed. We report here on this case with a review of the relevant literature.

직장의 평활근육종은 매우 드문 질환이며 항문 출혈, 직장통 같은 증상을 잘 동반하고 2~5.5 cm 크기로 발견되는 경우가 흔하다. 직장에서 생긴 평활근육종은 용종형태로 보이는 경우가 흔하며 대부분 고유근층에서 기원하고 점막근층이나 혈관의 근육에서도 발생한다. 높은 유사분열을 특징으로 하며 smooth muscle actin과 desmin에 염색이 되지만 c-kit와 S-100에는 염색이 되지 않는다. 저자들은 혈변을 주소로 내원한 54세 남자에서 4.5 cm 크기의 반유경성 용종을 기계적 올가미절제술로 절제하여 평활근육종으로 진단 후 직장 저위 전방 절제술과 보조 방사선 치료로 효과적으로 치료한 증례를 경험하여 문헌 고찰과 함께 보고한다.

Keywords

References

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