medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-423medsovet-7995Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONПерстневидноклеточная аденокарцинома толстой кишки: обзор и клиническое наблюдениеSignet ring-cell colorectal adenocarcinoma: review and clinical casehttps://orcid.org/0000-0002-0783-8709ЯшинС. С.YashinS. S.

Яшин Сергей Сергеевич - ассистент кафедры общей и клинической патологии: патологической анатомии, патологической физиологии.

443099, Самара, ул. Чапаевская, д. 89

Sergey S. Yashin - Assistant of the Department of General and Clinical Pathology: Pathological Anatomy, Pathological Physiology, Samara State Medical University.

89, Chapaevskaya St., Samara, 443099

s.s.yashin@samsmu.ruhttps://orcid.org/0000-0003-0026-309XЮнусоваЮ. Р.YunusovaYu. R.

Юнусова Юлия Рафаильевна - к.м.н., доцент кафедры общей и клинической патологии: патологической анатомии, патологической физиологии.

443099, Самара, ул. Чапаевская, д. 89

Yulija R. Yunusova - Cand. Sci. (Med.), Associate Professor of the Department of General and Clinical Pathology: Pathological Anatomy, Pathological Physiology, Samara State Medical University.

89, Chapaevskaya St., Samara, 443099

yu.r.yunusova@samsmu.ruhttps://orcid.org/0000-0003-2313-8873НосковК. К.NoskovK. K.

Носков Кирилл Константинович - студент Института клинической медицины.

443099, Самара, ул. Чапаевская, д. 89

Kirill K. Noskov - Student of the Institute of Clinical Medicine, Samara State Medical University.

89, Chapaevskaya St., Samara, 443099

steph.c@mail.ruhttps://orcid.org/0000-0001-6201-9725ИванюковА. С.IvanyukovA. S.

Иванюков Андрей Сергеевич - студент Института клинической медицины.

443099, Самара, ул. Чапаевская, д. 89

Andrey S. Ivanyukov - Student of the Institute of Clinical Medicine, Samara State Medical University.

89, Chapaevskaya St., Samara, 443099

andrivan200@yandex.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation202318012024022188195Copyright © Яшин С.С., Юнусова Ю.Р., Носков К.К., Иванюков А.С., 20242024Яшин С.С., Юнусова Ю.Р., Носков К.К., Иванюков А.С.Yashin S.S., Yunusova Y.R., Noskov K.K., Ivanyukov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7995

Колоректальный рак является одной из наиболее распространенных форм злокачественных новообразований в общей популяции и имеет множество гистологических подтипов. Перстневидноклеточная аденокарцинома представляет собой довольно редкий вариант данной патологии. Для нее характерны молекулярно-генетические и морфологические особенности, которые отсутствуют у классических аденокарцином, что обуславливает некоторые нюансы в клиническом течении и подходе к терапии данного типа опухоли. В представленном нами клиническом случае пациент 68 лет обратился к врачу общей практики с жалобами на боли в животе, изменения в акте дефекации, и по первичному физикальному и инструментальному обследованию ему был поставлен диагноз «Хронический дистальный колит», в дальнейшем назначена противовоспалительная терапия. Однако спустя полгода пациент повторно обратился к врачу с жалобами на ухудшение состояния и усиление симптомов, после обследования у него подтвердился диагноз аденокарциномы сигмовидной кишки, однако ввиду низкой приверженности лечению, а также поздней диагностики пациент скончался в течение полугода. Хирургическое лечение пациента было ограничено резекцией сигмовидной кишки ввиду спаечного процесса. В послеоперационном периоде клинически отмечалось развитие фибринозно-гнойного перитонита и нарастающей сердечно-сосудистой недостаточности. На патологоанатомическом вскрытии гистологический вариант поражения был изменен на перстневидноклеточную форму с метастазированием в печень и большой сальник. Смерть наступила от ДВС-синдрома с развитием острой почечной недосточности и центролобулярных некрозов печени. Клиническое наблюдение подчеркивает важность внедрения современных молекулярно-диагностических методов диагностики в широкую практику.

Colorectal cancer is one of the most common malignancies in the general population and has many histological subtypes. Signet-ring cell adenocarcinoma is a rather rare variant of this pathology. It is characterized by molecular genetic and morphological features that are absent in classical adenocarcinomas, which causes some nuances in the clinical course and approach to therapy of this type of tumor. In our clinical case, a 68-year-old patient went to a general practitioner with complaints of abdominal pain, changes in the act of defecation, and according to the primary physical and instrumental examination, he was diagnosed with chronic distal colitis, and later he was prescribed anti-inflammatory therapy. However, six months later, the patient went to the doctor again with complaints of worsening condition and symptoms, after examination, he was diagnosed with adenocarcinoma of the sigmoid colon, but due to low adherence to treatment, as well as late diagnosis, the patient died within six months. Surgical treatment of the patient was limited to resection of the sigmoid colon due to peritoneal adhesions. In the postoperative period, the development of fibrinous-purulent peritonitis and increasing cardiovascular failure were clinically noted. At autopsy, the histological variant of the lesion was changed to the signet-ring cell form with metastasis to the liver and greater omentum. Death occurred from disseminated intravascular coagulation syndrome with the development of acute renal failure and centrilobular necrosis of the liver. Clinical observation emphasizes the importance of introducing modern molecular diagnostic methods into wide practice.

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The authors declare that there are no conflicts of interest present.