Limits...
Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report.

Kishino T, Matsuda T, Sakamoto T, Nakajima T, Taniguchi H, Yamamoto S, Saito Y - BMC Gastroenterol (2010)

Bottom Line: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up.The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding.The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background: The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.

Case presentation: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

Conclusion: When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.

Show MeSH

Related in: MedlinePlus

Colonoscopy revealed that the SMT lesion had grown in size, with a reddish surface pitted with crater-like irregularities (a), after indigo carmine dye (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2925815&req=5

Figure 6: Colonoscopy revealed that the SMT lesion had grown in size, with a reddish surface pitted with crater-like irregularities (a), after indigo carmine dye (b).

Mentions: In 2007, the third follow up colonoscopy revealed a protruding submucosal tumor (SMT), 20 mm in size at the site of the 1996 EPMR (Figure 3 and 4). The biopsy specimen from the colonic mucosa did not demonstrate any malignancy. Therefore, we planned a follow up colonoscopy 6 months later. The follow up colonoscopy revealed that the SMT-like lesion had grown to a large size, with a reddish surface pitted with crater-like irregularities (Figure 5 and 6). Histopathological diagnosis confirmed an adenocarcinoma, and a laparoscopic-assisted sigmoidectomy with D3 lymph node resection was performed in 2007. Histopathological analysis of the resected lesion revealed a moderately differentiated adenocarcinoma, and the depth of invasion was subserosa with lymph node metastasis, lymphovascular invasion, venous invasion and perineural invasion (Figure 7).


Recurrent advanced colonic cancer occurring 11 years after initial endoscopic piecemeal resection: a case report.

Kishino T, Matsuda T, Sakamoto T, Nakajima T, Taniguchi H, Yamamoto S, Saito Y - BMC Gastroenterol (2010)

Colonoscopy revealed that the SMT lesion had grown in size, with a reddish surface pitted with crater-like irregularities (a), after indigo carmine dye (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2925815&req=5

Figure 6: Colonoscopy revealed that the SMT lesion had grown in size, with a reddish surface pitted with crater-like irregularities (a), after indigo carmine dye (b).
Mentions: In 2007, the third follow up colonoscopy revealed a protruding submucosal tumor (SMT), 20 mm in size at the site of the 1996 EPMR (Figure 3 and 4). The biopsy specimen from the colonic mucosa did not demonstrate any malignancy. Therefore, we planned a follow up colonoscopy 6 months later. The follow up colonoscopy revealed that the SMT-like lesion had grown to a large size, with a reddish surface pitted with crater-like irregularities (Figure 5 and 6). Histopathological diagnosis confirmed an adenocarcinoma, and a laparoscopic-assisted sigmoidectomy with D3 lymph node resection was performed in 2007. Histopathological analysis of the resected lesion revealed a moderately differentiated adenocarcinoma, and the depth of invasion was subserosa with lymph node metastasis, lymphovascular invasion, venous invasion and perineural invasion (Figure 7).

Bottom Line: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up.The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding.The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background: The high frequency of local recurrence occurring after endoscopic piecemeal resection (EPMR) for large colorectal tumors is a serious problem. However, almost all of these cases of local recurrence can be detected within 1 year and cured by additional endoscopic resection. We report a rare case of recurrent advanced colonic cancer diagnosed 11 years after initial EPMR treatment.

Case presentation: A 65-year-old male was diagnosed with a sigmoid colon lesion following a routine health check-up. Total colonoscopy revealed a 12 mm type 0-Is lesion in the sigmoid colon, which was diagnosed as an adenoma or intramucosal cancer and treated by EPMR in 1996. The post-resection defect was closed completely using metallic endoclips to avoid delayed bleeding. In 2007, at the third follow up, colonoscopy revealed a 20 mm submucosal tumor (SMT) like recurrence at the site of the previous EPMR. The recurrent lesion was treated by laparoscopic assisted sigmoidectomy with lymph node dissection.

Conclusion: When it is difficult to evaluate the depth and margins of resected tumors following EPMR, it is important that the defect is not closed in order to avoid tumor implantation, missing residual lesions and to enable earlier detection of recurrence. It is crucial that the optimal follow-up protocol for EPMR cases is clarified, particularly how often and for how long they should be followed.

Show MeSH
Related in: MedlinePlus