Detection of Ulcerative Colitis-associated Rectal Cancer with Endoscopic Ultrasound Seiji Shimizu 1 , Hideo Tomioka 1 , Kiyoshi Ogiso 1 , Kyohei Ikeda 1 , Hirokazu Uejima 1 , Chihiro Yokomizo 1 , Hidetaka Takashima 1 , Yusuke Okuyama 2 1Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan 2Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan Keyword: 潰瘍性大腸炎関連大腸癌 , UC関連大腸癌 , colitic cancer , 超音波内視鏡 , EUS pp.201-207
Published Date 2020/2/25
DOI https://doi.org/10.11477/mf.1403201952
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 We report a case of rectal cancer associated with UC(ulcerative colitis)detected by EUS(endoscopic ultrasound). The patient was a man in his 30s with a 19-year history of relapsing-remitting type UC affecting the entire colon. Sigmoidoscopy was performed to evaluate the disease activity and revealed multiple polypoid lesions in the proximal portion of the rectum. At the same time, EUS revealed a distinct hypoechoic area in the submucosa beneath and around the polypoid lesion on the most oral side. A cluster of poorly differentiated adenocarcinoma and signet ring cells were observed in the biopsy specimen taken from the lesion. After careful evaluation, a subtotal colectomy was performed. On inspection of the resected specimen, a depressed lesion approximately 15mm in diameter was observed around the prominence in the proximal portion of the rectum. Histologically, the lesion was a poorly differentiated, mucinous, and signet ring cell carcinoma invading the deepest portion of the submucosa with a skipped cluster of cancer cells in the subserosa. Histological examination of the polypoid lesion on the anal side revealed a well-differentiated adenocarcinoma that was limited to the mucosa. The two cancers were surrounded by flat dysplasia and there were no metastases in the dissected lymph nodes. These findings prove that EUS may be helpful for detecting invasive cancer associated with UC.

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