A case of Rendu-Osler-Weber disease associated with simultaneous, multiple advanced cancers in the colon
A 77-year-old male having multiple small nevi over the lips, face, mucous membrane of mouth, tongue, neck and thorax was admitted to our hospital because of severe anemia. He has been diagnosed as Rendu-Osler-Weber disease (Osler's disease) since his 42 years of age. Although the stools were positive for occult blood, hematologic examination disclosed no abnormalities except for severe hypochromic and microcytic anemia. Gastrointestinal examination showed multiple stigmata in the esophagus, stomach, duodenum, and several tumors in the colon. Histological findings of biopsy specimens obtained from these tumors revealed adenocarcinomas and tubular adenomas. Surgical resection was carried out. Resected specimens showed two tumors (one is in ascending colon appeared to be 2 type carcinoma, 1.9 x 2.3 cm in size, another is in caecum, 3 type, 7.0 x 5.0 cm in size) and three Yamada-II approximately III type polyps. Pathohistologically, the tumor in ascending colon showed moderately differentiated adenocarcinoma, another one in caecum showed mucinous carcinoma, and polyps showed tubular adenomas, respectively. Unfortunately, the anemia of this case was regarded as stemming from Osler's disease, so the precise gastrointestinal examination was not performed for a long time. It should be emphasized to be faithful to the fundamentals of medical diagnosis.