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Collision Tumor of Adenoma and Adenocarcinoma in the Rectum Diagnosed Via Genetic Analysis, Barium Enema, and Conventional and Magnifying Endoscopy, Report of a Case Masahiro Kondo 1 , Keisuke Kawasaki 1 , Shinichiro Kawatoko 1,2 , Ryutaro Mizue 3 , Tomohiro Nagasue 3 , Yuichi Matsuno 3 , Junji Umeno 3 , Tomohiko Moriyama 1,4 , Yoshiaki Taniguchi 2 , Kenichi Kohashi 5 , Shun Yamada 6 , Tamotsu Sugai 6 , Takehiro Torisu 1 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 2Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan 4International Medical Department, Kyushu University Hospital, Fukuoka, Japan 5Department of Diagnostic Pathology, Osaka Metropolitan University, Osaka, Japan 6Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate, Japan Keyword: 直腸癌 , 大腸癌 , 衝突癌 , 衝突腫瘍 , 腺腫 pp.259-268
Published Date 2024/2/25
DOI https://doi.org/10.11477/mf.1403203479
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 A 70-year-old man underwent colonoscopy for colorectal cancer screening, which revealed a flat-elevated lesion with central depression in the lower rectum and a small protruding lesion in the right side of the flat-elevated lesion. Magnifying narrow-band imaging endoscopy and chromoendoscopy revealed an irregular surface and vessel pattern in the flat-elevated lesion and a regular surface and vessel pattern in the small protruding lesion. The tentative diagnosis was intramucosal or early cancer with slight submucosal invasion. Endoscopic findings of the small protruding lesion suggested tubular adenoma. He was subsequently treated via endoscopic submucosal dissection. Histological examination of the resected specimen showed a well-differentiated adenocarcinoma invading the shallow submucosal layer(invasion depth:400μm). The small protruding lesion in the right side of the flat-elevated lesion was a tubular adenoma. The horizontal and vertical margins were free of tumor cells. Molecular analysis revealed that the adenoma component was positive for NRAS and APC mutations, whereas the adenocarcinoma component was negative for NRAS and APC mutations. Therefore, he was diagnosed with collision tumor of adenoma and adenocarcinoma.


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