Villous Tumor Of The Rectum Accompanied By Electrolyte Depletion, Report Of A Case

A 46-year-old man was admitted in June 1985 because of profuse mucoid rectal discharge and general malaise. Initially, diarrhea occurred once a day four years ago and later, followed by 8–10 bowel movements daily. During the hospitalization, the patient passed much mucus (1300 to 1800 ml per day) per rectum. On digital examination, a soft and non-tender mass was palpable at the tip of the examining finger. Serum Na was 141.6 mEq/L, K 3.3 mEq/L, and Cl 103.1 mEq/L. Fecal Na was 118.2 mEq/L, K 20.0 mEq/L, and Cl 108.8 mEq/L. Barium enema study revealed a huge tumor with a shaggy nap feature in the rectum. Sigmoidofiberscopy showed a soft mass which had nodularity and mucus on the surface. Histologic finding of the biopsy specimens revealed villous adenoma with severe atypia suggesting malignancy. He underwent Miles operation. In the resected specimen, the huge tumor measuring 17X18X3.0 cm occupied the entire circumference of the lumen and had a granular surface without ulceration. Histologic finding of the resected specimen showed villous adenoma restricted largely to the mucosa except for a small area of submucosal invasion which revealed well differentiated adenocarcinoma proliferating in a villo-tubular pattern. One of the lymph nodes attached to the rectal wall was involved by the tumor. Postoperatively, the serum potassium returned to normal and the patient made an uneventful recovery. Villous tumor with electrolyte depletion has been rarely reported in Japan.