A Case of Multiple Adenomas and Adenocarcinomas of the Colon with the Background of Diffuse Nodular Hyperplasia T. Hirooka 1 , S. Nakamura 3 , I. Kino 3 , H. Yuasa 1 , S. Yoshida 1 , M. Nishikino 2 , Y. Kooda 2 1Department of Internal Medicine, Shida General Hospital 2Department of Surgery, Shida General Hospital 3Department of Pathology, Hamamatsu University School of Medicine pp.987-994
Published Date 1980/9/25
DOI https://doi.org/10.11477/mf.1403112799
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 A 38 year-old man was admitted to hospital with a chief complaint of diarrhea. Family history revealed that his sister had been operated on because of rectal cancer at the age of 36.

 The patient had barium enema examination in April 1977, which showed a Ⅱa+Ⅱc-like elevated lesion with two pedunculated polyps and coarse granular changes of mucosa in the colon. Pedunculated lesions were diagnosed as adenoma by endoscopic polypectomy, and the elevated lesion was diagnosed as adenocarcinoma by biopsy. Rather limited descending colectomy was performed considering early cancer (sm cancer).

 Barium enema, performed 6 months after operation, disclosed multiple small flat elevated lesions, less than 5 mm in diameter, which appeared in the midportion of transverse colon and became more crowded toward the distal part of the colon, especially from the anastomosis to the rectum. Endoscopically, colonic mucosa showed edema and only scattered foci of elevation.

 Histologically mucosa of the resected colon showed diffuse multiple hyperplastic nodules with infrequent metaplastic polyps less than 5 mm in diameter.

 With the background of these diffuse nodules, there were microadenomas and intramucosal microcarcinoma, 2 mm in size, in addition to the above described sm cancer and adenomas. Also observed was abnormal glandular hyperplasia even in the flat, normal appearing mucosa.

 Therefore, it can be concluded that adenomas and cancers in this case developed from the mucosa with a background of diffuse nodular hyperplasia, and this combination seems to be very rare from the standpoint of diffuse mucosal abnormality of the colon.

Copyright © 1980, Igaku-Shoin Ltd. All rights reserved.


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