摘要：
Objective To retrospectively review the clinical manifestations,pathological characteristics and outcomes of colorectal carcinoma and compare them with those of adults.Methods Between January 2010 and January 2016,3401 patients with colorectal carcinoma were hospitalized.There were 4 boys and 2 girls with a mean age of 13 years.Six of them (0.17％) were aged under 14 years.All diagnoses were confirmed by pathological examination.Two age groups of adult patients were randomly sampled 20-30 years (n=17) and 50-60 years (n=67) and their clinical presentations and pathological characteristics were compared with those of adults.Results The presenting manifestations included abdominal pain,hematochezia,abdominal mass,intestinal obstruction,and change in frequency/form of stool.Tumor locations included colon (n=5) and rectum (n=1).The pathological diagnoses were mucinous adenocarcinoma (n=2),signet-ring cell carcinoma (n=3) and ductal carcinoma (n=1).Metastasis was regional lymphatic (n=5) and distant (n=1).One case had intestinal neuronal dysplasia while another was operated plus adjuvant chemotherapy for hepatoblastoma 10 years previously.Three of them received chemotherapy.Until 30 August 2016,there were death (n=3),lost to follow-up (n=1) and survival (n=2).Two survivors had a worse quality of life than healthy controls.The adult dominant presenting symptom was altered stool habit.Their pathological diagnoses were ductal carcinoma,poorly differentiated adenocarcinoma,signetring cell carcinoma and mucinous adenocarcinoma in those aged 20-30 years versus ductal carcinoma,mucinous adenocarcinoma,papillary tubular adenocarcinoma,poorly differentiated adenocarcinoma and undifferentiated cancer in those aged 50-60 years.Conclusions Pediatric colorectal carcinoma is extremely rare and our reviewed cases account for 0.17％ of all reported cases.The clinical presentations are similar for children and adults.However,children present predominantly with recurrent abdominal pain,hematochezia,abdominal mass,intestinal obstruction and rarely alteration in stool habit,whereas this is the commonest presenting symptom in adults.Most tumors are located in colon.Mucinous adenocarcinoma and signet-ring cell carcinoma are the major pathological diagnoses in children.And most of them have regional lymphatic metastases while ductal carcinoma is more common in adults.%目的 回顾性分析6例儿童结、直肠恶性肿瘤患儿的临床表现、病理特征及疾病转归,同时寻找与成人临床病理不同点.方法 回顾性分析2010年1月至2016年1月共收治的结、直肠癌患儿共3 401例,其中＜14岁以下6例,占0.17％.男4例,女2例,平均年龄13岁,均经病理检查证实.同时在同期20 ～ 30岁年龄组和50 ～ 60岁年龄组中采用随机数字表法随机抽样分别产生17例和67例病例,分别与儿童结、直肠癌临床表现、病理特征做一比较.结果 临床表现以腹痛、便血、腹部肿块、肠梗阻为主,1例有大便习性改变.病理特征:肿瘤部位在结肠5例,直肠1例.病理诊断:结肠黏液腺癌2例,印戒细胞癌3例,管状腺癌1例,均有区域性淋巴结转移,1例远处转移.病理检查中还发现1例合并肠神经元发育异常改变(例6).例2十年前曾做肝母细胞瘤切除,辅以化疗,此为二次肿瘤.6例儿童均予以化疗,至随访日(2016年8月30日)有3例死亡,1例失随访,2例存活,继续化疗中.后者生活质量低于同龄儿童.对照20～30岁年龄组,与50～60岁年龄组,后二组临床表现则以大便习性改变为主.从病理特征分析,20～30岁组以管状腺癌、低分化腺癌、印戒细胞癌、黏液腺癌(以多少排序)多见,50～60岁组以管状腺癌、黏液腺癌、乳头状管状腺癌、低分化腺癌、未分化癌(以多少排序)多见.结论 儿童结、直肠癌罕见,本组6例占全年龄段结、直肠癌数中0.17％.临床表现仍与成年人结、直肠癌相似,但首发症状以反复腹痛、便血、腹部肿块、肠梗阻为主,大便习性改变少见.而成年人结、直肠癌则以大便习性改变为主.儿童结肠部位多见,以黏液腺癌和印戒细胞癌为主,大多有周边淋巴转移.成年组以管状腺癌为主,儿童结肠癌有肠神经元发育异常.
