A CASE OF VILLOUS TUMOR OF THE RECTUM WITH CANCER CHANGE AND ELECTROLYTE DEPLETION SYNDROME

Abstract

A surgically treated case of villous tumor of the rectum is reported. A 58-year old woman was admitted to the hospital because of palpitation and general fatigue. Laboratory examination revealed hypokalemia and severe anemia. Barium enema and colon fiberscopy showed a large soft and cauliflower-shaped tumor occupying the pelvic space. A biopsy of the rectal tumor proved adenocarcinoma. We diagnosed the case as rectal villous tumor followed by cancer change and electrolyte deplesion syndrome (EDS). Although the cancer change of villous tumor occurs in a high rate, the size of tumors do not always reflect the depth of invasion to the rectal wall. So transanal endoscopic microsurgical excision (TEME) or surgical treatment such as local excision or bowl resection is precedentory employed for rectal tumors, except those being clearly suspicious of malignancy. It has been reported, however, that the recurrence rate after TEME or local excision is 17.5-50%, indicating the importance of surgical margin and periodic endoscopic observation of clinical course. In our case, abdominoperineal resection was performed because of its size and location. The postoperative course has been uneventful and EDS has been improved. Postoperative histological findings revealed well differentiated adenocarcinoma in all parts of the villous tumor.