title: Adenocarcinoma arising below an ileoanal anastomosis after restorative proctocolectomy for ulcerative colitis: report of a case.
abstract: We report a case of adenocarcinoma developing in remnant rectal mucosa below a hand-sewn ileal pouch-anal anastomosis (IPAA) after restorative proctocolectomy for ulcerative colitis (UC). To our knowledge, this is the first such case to be reported from Japan. A 60-year-old man with a 13-year history of UC underwent proctocolectomy with a hand-sewn IPAA and mucosectomy for anal stenosis and serious tenesmic symptoms. About 7 years later, a follow-up endoscopy showed a flat elevated malignant lesion, 2 cm in diameter, below the ileoanal anastomosis. He was treated by abdominoperineal resection of the pouch and anus with total mesorectal excision. Histopathological examination of the resected specimen confirmed the presence of a well-differentiated adenocarcinoma but there were no metastatic lymph nodes. He recovered uneventfully and remains well without evidence of recurrent disease 2 years and 3 months after his last operation.
authors.affiliation: Department of Surgery, Osaka Saiseikai Senri Hospital, 1-1 D6 Tsukumodai, Suita, Osaka, 565-0862, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ota
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Wakio
authors.initials: W
authors.lastname: Endoh
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Hojo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fukunaga
authors.forename: Setsuko
authors.initials: S
authors.lastname: Yoshioka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Okada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Okamoto
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Ueda
authors.forename: Yoshiichi
authors.initials: Y
authors.lastname: Maeura
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000209:etiology* / Q000473:pathology; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001005:Anus Neoplasms / Q000209:etiology* / Q000473:pathology; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery; D003113:Colonoscopy; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007413:Intestinal Mucosa; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012007:Rectum / Q000601:surgery*