GC.10083
From a male aged 62 who for four years had suffered from “diarrhoea with passage of mucopus. During the last four months he had noted occasional haemorrhage during defecation. He had attributed this to piles. Rectal examination revealed a large fungating craggy mass encircling the bowel. Radiographic examination after barium enema revealed the presence of a second growth in the sigmoid colon. At operation a third growth, somewhat smaller, was found at a slightly higher level. The remainder of the colon appeared healthy and there was no evidence of spread to the retroperitoneal lymph nodes, peritoneum or liver. The sigmoid colon and rectum were removed by the abdominoperineal method, successfully. (15.UEE. 4/1. F(1).
The specimen presents three carcinomata which appear to be quite separate growths. The lowest, which extends down to within 100 mm. of the anus and measures 75 mm. in length, completely encircles the gut. For the greater part it consists of a low growth of villous appearance, and when it is cut across (at the left edge of the specimen) it presents the appearance of a diffuse papillomatosis. This appearance is confirmed by microscopic examination. The remainder of the lowest growth, seen cut across at the right edge of the specimen, forms a large hard mass, obviously malignant, with a cut surface of somewhat gelatinous appearance. Microscopic examination shows this part of the tumour to be a papillary carcinoma with some colloid change. In the sigmoid colon, and separated from the rectal growth by some 60 mm. of apparently healthy gut, is a second tumour. This is a massive, sessile growth, indurated, superficially ulcerated, and obviously malignant It also presents a distinctly gelatinous appearance. Microscopically it is an adenocarcinoma with colloid change. The third growth, situated some 30-40 mm. further proximally, is a small bard sessile carcinoma, similar in microscopic structure to the second one. It will be noted that there is remarkably little evidence of lymphatic invasion. The only lymph nodes involved are of small size and situated within the sheath of the rectum closely related to the rectal growth. From consideration of the clinical history, it would seem that the primary lesion was a diffuse papillomatosis of the rectum. Subsequently this lesion led to the formation of the rectal carcinoma. It is interesting to speculate whether the second and third arose as a result of lymphatic penetration from the rectal growth, or were independent formations.
