Stomach and Intestine(Tokyo) Volume 53, Issue 13 (December 2018)

Flat and Depressed Type Intramucosal Carcinoma in the Rectum with Challenging Invasion Depth Diagnosis Because of Inverted Muscularis Mucosae, Report of a Case Takahiro Sasaki 1 , Yusuke Saitoh 1 , Masaki Taruishi 1 , Ryuji Sugiyama 1 , Ryuji Sukegawa 1 , Yuhei Inaba 1 , Kenichiro Ozawa 1 , Akio Takada 2 1Digestive Disease Center, Asahikawa City Hospital, Asahikawa, Japan 2Division of Pathology, Asahikawa City Hospital, Asahikawa, Japan Keyword: 早期大腸癌 , 内反 , 形態変化 , EUS pp.1800-1807
Published Date 2018/12/25
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 In a male patient in his sixties, a 5-mm submucosal tumor-like lesion with reddish central protrusion was detected on colonoscopy. The 10-month follow-up colonoscopy revealed that the lesion size remained unchanged, but its shape changed to a flat elevated lesion with a central depression. Endoscopic ultrasonography revealed that hypoechoic tumor invaded the submucosal layer with 3,000-μm invasion distance, and the submucosal space was visualized between the tumor invasion front and proper muscle layer. However, the preoperative diagnosis was submucosal invasive cancer with moderate amount ; the lesion was small, and the submucosal space was visualized between the tumor invasion front and proper muscle layer by EUS. In addition, endoscopic submucosal dissection was performed, and en-block resection with negative vertical margin was accomplished. Histopathological specimens revealed well-differentiated intramucosal carcinoma(Tis)ly0, v0, HM(−), VM(−)mimicking submucosal(T1)carcinoma because of inverted muscularis mucosae into the submucosal layer.

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53巻13号 (2018年12月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院