Pedunculated early colorectal cancer with nodal metastasis: a case report

Abstract Background Pedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis. Case presentation A 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 μm from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery. Conclusions Additional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature.

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Early Pedunculated Colorectal Cancer with Nodal Metastasis: A Case Report

10.21203/rs.3.rs-596640/v1 ◽

2021 ◽

Author(s):

Hiroka Kondo ◽

Shimpei Ogawa ◽

Takeshi Ohki ◽

Yoshiko Bamba ◽

Yuka Kaneko ◽

...

Keyword(s):

Colorectal Cancer ◽

Endoscopic Resection ◽

Bowel Resection ◽

Intestinal Resection ◽

Lymphatic Invasion ◽

Nodal Metastasis ◽

Fecal Occult Blood ◽

Poorly Differentiated Adenocarcinoma ◽

Additional Surgery ◽

Poorly Differentiated

Abstract Background: Among early colorectal cancers, pedunculated polyps have a higher complete resection rate than non-pedunculated cases and rarely require additional surgery. However, this time, we experienced a case of pedunculated colorectal cancer, which was histologically poorly differentiated adenocarcinoma. Lymphatic invasion was also found, so additional intestinal resection was performed and nodal metastasis was found.Case presentation: A 43-year-old woman underwent colonoscopy because of positive fecal occult blood. A 20 mm-sized pedunculated polyp was found in the descending colon, and endoscopic resection was performed. Histopathological examination revealed non-solid poorly differentiated adenocarcinoma, invading to the submucosa (3,500 μm from the muscularis mucosae) with lymphatic invasion. In spite of its early stage cancer, the risk of nodal metastasis was considered to be high, and bowel resection was additionally performed. Although there was no residual cancer in the site after endoscopic resection, a metastasis was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy. There was no evidence of recurrence after three months after the additional surgery. Conclusions:　 For pedunculated polyps, additional bowel resection was performed for patients with multiple risk factors for nodal metastasis such as poorly differentiated adenocarcinoma and positive lymphatic invasion. Then, we experienced a case of nodal metastasis, so we report it with a review of the literature.

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Association of Poor Differentiation or Positive Vertical Margin with Residual Disease in Patients with Subsequent Colectomy after Complete Macroscopic Endoscopic Resection of Early Colorectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2017/7129626 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8

Author(s):

Ki Ju Kim ◽

Hyun Seok Lee ◽

Seong Woo Jeon ◽

Sun Jin ◽

Sang Won Lee

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Endoscopic Resection ◽

Resection Margin ◽

Residual Disease ◽

Early Colorectal Cancer ◽

Residual Cancer ◽

Mucinous Histology ◽

Poor Differentiation ◽

Poorly Differentiated

In the presence of unfavorable pathologic results after endoscopic resection of colorectal cancer, colectomy is routinely performed. We determined the risk factors for residual diseases in patients with colectomy after complete macroscopic endoscopic resection of early colorectal cancer. We identified consecutive patients who underwent endoscopic resection of early colorectal cancer and subsequently underwent colectomy, from January 2011 to December 2014. Clinicopathologic risk factors related to the residual disease were analyzed. In total, 148 patients underwent endoscopic resection and subsequent colectomy. Residual disease on colectomy was noted in 16 (10.9%) patients. The rates of poorly differentiated/mucinous histology (p=0.028) and of positive or unknown vertical resection margin (p=0.047) were higher in patients with residual disease than in those without. In multivariate analysis, a poorly differentiated/mucinous histology and positive or unknown vertical resection margin were significantly associated with residual disease (odds ratio = 7.508 and 2.048, p=0.015 and 0.049, resp.). After complete macroscopic endoscopic resection of early colorectal cancer, there is a greater need for additional colectomy in cases with a positive or unknown vertical resection margin or a poorly differentiated/mucinous histology, because of their higher risk of residual cancer and lymph node metastasis.

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Five-Year Survival after Surgery for Invasive Micropapillary Carcinoma of the Stomach

Case Reports in Surgery ◽

10.1155/2013/560712 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Shigeo Ninomiya ◽

Kazuya Sonoda ◽

Hidefumi Shiroshita ◽

Toshio Bandoh ◽

Tsuyoshi Arita

Keyword(s):

Lymphatic Invasion ◽

Nodal Metastasis ◽

Upper Gastrointestinal Endoscopy ◽

Invasive Micropapillary Carcinoma ◽

Micropapillary Carcinoma ◽

Poorly Differentiated Adenocarcinoma ◽

Poorly Differentiated ◽

Upper Abdominal ◽

Micropapillary Component ◽

Upper Gastrointestinal

Invasive micropapillary carcinoma (IMPC) of the breast, urinary bladder, ovary, and colon has been reported. However, few reports have described IMPC of the stomach. In addition, IMPC has been described as a histological indicator for lymphatic invasion and nodal metastasis, resulting in poor prognosis. We report a case of 5-year survival after surgery for IPMC of the stomach. A 69-year-old woman was admitted to our hospital with symptoms of upper abdominal pain. Upper gastrointestinal endoscopy revealed a tumor at the antrum of the stomach. Histological examination of the biopsy specimen indicated poorly differentiated adenocarcinoma. The patient underwent distal gastrectomy with lymph node dissection. Microscopic examination of the specimen revealed that the tumor consisted of an invasive micropapillary component. Carcinoma cell clusters were floating in the clear spaces. The patient recovered uneventfully and remains alive without recurrence 5 years after surgery.

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Risk of recurrence after endoscopic resection of early colorectal cancer with positive margins

Endoscopy ◽

10.1055/s-0043-120441 ◽

2017 ◽

Vol 50 (03) ◽

pp. 241-247 ◽

Cited By ~ 5

Author(s):

Je-Wook Shin ◽

Kyung Han ◽

Jong Hyun ◽

Sang Lee ◽

Bun Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Endoscopic Resection ◽

Resection Margin ◽

Salvage Surgery ◽

Positive Margin ◽

Residual Tumor ◽

Early Colorectal Cancer ◽

Clinicopathological Factors ◽

Positive Resection Margin ◽

Additional Surgery

Abstract Background and study aim Additional surgery is recommended if an endoscopically resected T1 colorectal cancer (CRC) specimen shows a positive resection margin. We aimed to investigate the significance of a positive resection margin in endoscopically resected T1 CRC. Patients and methods We enrolled 265 patients with T1 CRC who underwent endoscopic resection between January 2001 and December 2016. The inclusion criteria were: 1) complete resection by endoscopy, and 2) pathology of a positive margin. Among the 265 patients, 213 underwent additional surgery and 52 did not. In the additional surgery group, various clinicopathological factors were evaluated with respect to the presence or absence of residual tumor. The follow-up results were assessed in the group that did not undergo additional surgery. Results In the 213 patients who underwent additional surgery, residual tumor was detected in 13 patients (6.1 %), and none of the clinicopathological factors was significantly associated with the presence of residual tumor. Among the 52 patients who did not undergo additional surgery, recurrence was detected in 4 (7.7 %), and all 4 underwent salvage surgery. Among these four patients, three had no risk factors for lymph node metastasis and recurrence was at the previous resection site; pathology was high grade dysplasia, rpT3N0M0, and rpT1N0M0, respectively. Conclusions A positive resection margin in endoscopically resected T1 CRC is related to a relatively low incidence of residual tumor (6.1 %). Although current guidelines recommend additional surgery for such cases, surveillance and timely salvage surgery could be another option in selected cases.

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