A Case of Node-positive, Is-type Rectal Cancer Measuring 5mm in Diameter

Terumitsu Sawai¹⁾²⁾, Takashi Tsuji¹⁾²⁾, Atsushi Nanashima²⁾, Masaaki Jibiki²⁾, Hiroyuki Yamaguchi²⁾, Toru Yasutake²⁾, Tohru Nakagoe²⁾ and Hiroyoshi Ayabe²⁾

¹⁾Department of Surgery, Hiura Hospital
²⁾First Department of Surgery, Nagasaki University School of Medicine

A 49-year-old man who had undergone cholecystectomy for cholecystolithiasis visited our hospital for lower abdominal pain and diarrhea.. A colonoscopy revealed a protruded lesion with a double elevation, measuring 5 mm in diameter in the upper rectum, 10 cm from the anal verge. Under the diagnosis of tubular adenoma, the lesion was removed by endoscopic polypectomy. Histological findings showed moderately differentiated adenocarcinoma invasion to the submucosa (sm), and was markedly suggestive of submucosal vertical margin involvement. Four weeks after the polypectomy, low anterior resection with dissection of group 1 and group 2 lymph nodes were performed. Although there was no residual carcinoma, metastases were found in three of the 16 dissected nodes. The present case illustrates that minute protruded colorectal carcinomas can have SM invasion, and that the double elevation is useful in diagnosing the massive SM invasion of these lesions.

Key words
minute Is-type submucosal rectal cancer, double elevation, endoscopic diagnosis of submucosal colorectal cancer

Reprint requests
Terumitsu Sawai First Department of Surgery, Nagasaki University School of Medicine1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
March 31, 1999

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