Local Recurrence of Intramucosal Cancer in the Rectum after En bloc Complete Resection, Report of a Case Toshitatsu Takao 1 , Yuichiro Yamaguchi 1 , Ichiro Ito 2 , Hisatomo Ikehara 3 , Kinichi Hotta 1 , Madoka Takao 1 , Masaki Tanaka 1 , Naomi Kakushima 1 , Kohei Takizawa 1 , Hiroyuki Matsubayashi 1 , Hiroyuki Ono 1 , Tadakazu Shimoda 4 1Endoscopy Division, Shizuoka Cancer Center, Suntogun, Japan 2Division of Pathology, Shizuoka Cancer Center, Suntogun, Japan 3Upper Gastroenterology, Hyogo college of medicine, Nishinomiya, Japan 4Center for Cancer Control and Information Services, National Cancer Center, Tokyo Keyword: 大腸ESD , 局所再発 , 早期大腸癌 , 粘液癌 , リンパ管侵襲 pp.1954-1960
Published Date 2013/12/25
DOI https://doi.org/10.11477/mf.1403114032
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 We report a case of local recurrence of intramucosal cancer after en bloc complete resection. We performed colorectal ESD(endoscopic submucosal dissection)for a male patient in his 70s with a protruding tumor, measuring 30mm in the lower rectum. The lesion was histologically diagnosed as carcinoma in tubulovillous adenoma with tumor-free margin and no vessel invasion. However, the follow-up colonoscopy 1year after ESD showed a SMT(submucosal tumor)next to the post-ESD scar. We performed ESD as total biopsy again and diagnosed the lesion as mucinous cancer with submucosal or deeper invasion. To elucidate the cause of the local recurrence, we examined deeply cut sections of the initial lesion and lymphatic invasion was newly found. There is no reported case of a local recurrent lesion composed of mucinous cancer in the shape of SMT after intramucosal cancer has been resected en bloc with tumor-free margin. This case indicates the importance of multiple step cut sections to find out lymphatic invasion, whenever cutting stride cannot be shortened because of villous structures which could be easily destroyed by cutting.

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