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Dtsch Med Wochenschr 2017; 142(17): 1300-1303
DOI: 10.1055/s-0043-106879
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Colitis ulcerosa und Adenokarzinom der Appendix vermiformis: Kausaler Zusammenhang?

Ulcerative Colitis and Adenocarcinoma of the Appendix: Is there a Causal Link?
Bonnie Stahn   *
,
Catharina Hartmann   *
,
Thomas Heinig
,
Lorenz Scheit
Further Information

Publication History

Publication Date:
29 August 2017 (online)

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Zusammenfassung

Anamnese Wir berichten von einem 57-jährigen Patienten, der sich mit ausgeprägter Gewichtszunahme in kurzer Zeit und Stuhlunregelmäßigkeiten vorstellte.

Diagnostik In der anschließenden Diagnostik zeigte sich eine vermutlich seit Jahren bestehende Colitis ulcerosa sowie bei Nachweis von Adenokarzinomzellen im Aszitespunktat die Diagnose eines CUP-Syndroms.

Es folgten weitere umfangreiche diagnostische Maßnahmen ohne sichere Identifizierung eines Primarius. Schließlich wurde der Entschluss zur Kolektomie gefasst. In der histopathologischen Aufbereitung wurde ein Appendix-Karzinom im fortgeschrittenen Stadium festgestellt.

Therapie und Verlauf Die geplante Chemotherapie konnte aufgrund des sich rapide verschlechternden Zustands des Patienten nicht mehr durchgeführt werden. Es erfolgte die Entlassung in die Häuslichkeit zur palliativen Versorgung.

Folgerung Ein Appendix-Karzinom ist eine sehr seltene Erkrankung, der Zusammenhang mit einer Colitis ulcerosa ungewiss. Dennoch sollte insbesondere bei einem CUP-Syndrom eine Neoplasie der Appendix als möglicher Primarius in Erwägung gezogen werden.

Abstract

Anamnesis We report the case of a 57-year-old patient initially seen with stool irregularities and malignant ascites.

Diagnostics Through further examinations we diagnosed a long standing untreated ulcerative colitis with endoscopic signs of a massive chronic inflammation of the entire colon. The origin of the malignant cells in the ascites remained unknown despite the exhaustion of all diagnostic means available. As an ultima ratio we performed a colectomy and an advanced adenocarcinoma of the appendix was found.

Clinical course The patient’s condition deteriorated very fast so that chemotherapy wasn’t an option. Following his wishes he received palliative care in his home environment.

Conclusion Patients with an inflammatory bowel disease have a higher risk of developing colorectal cancer. This is a well-known fact. But an adenocarcinoma of the appendix is still a rarity. Here we illuminate the possible link between the appendix and ulcerative colitis.

Schlüsselwörter

Appendix-Karzinom - Colitis Ulcerosa - CUP-Syndrom

Key words

carcinoma of the appendix - ulcerative colitis - CUP-syndrome

* geteilte Erstautorenschaft


 

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