Two Cases of Mucinous Carcinoma Developing below the Mucosal Layer after Transsacral Local Resections for Rectal Adenoma and In situ Adenocarcinoma

Seiji Ito, Takashi Hirai and Tomoyuki Kato

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital

Two cases of mucinous carcinoma are reported which developed below the mucosal layer after local resections of a rectal adenoma and in situ adenocarcinoma. Case 1: A patient with a rectal polyp underwent endoscopic resection of the polyp. The polyp recurred, and it was then resected by a trans-sacral procedure. Pathological examination of the tumor on both occasions revealed a tubulovillous adenoma. Two years and 3 months later, a submucosal tumor which developed at the same site was locally resected. Pathological examination this time revealed a mucinous carcinoma in the submucosa, hence a low anterior resection was performed in addition. Case 2: The patient had undergone transsacral resection of in situ adenocarcinoma of the rectum. Three months later, the rectal polyp recurred and was resected by a trans-anal procedure. The pathological diagnosis was villous adenoma. Subsequently, the polyps recurred three times and were resected endoscopically, but the pathological diagnosis each time was adenoma with either mild or moderate atypia. The rectal polyp recurred yet again, but this time a submucosal tumor was suspected from digital examination and endoscopic ultrasonography (EUS). Since incisional biopsy of the tumor revealed an adenoma in the mucosal layer and mucinous carcinoma in the submucosal layer, an abdominoperineal resection was performed. Thus, while following up patients after trans-sacral resection of rectal neoplasms, it is important to be on the lookout for such a submucosal recurrence.

Key words
rectal mucinous carcinoma, trans-sacral excision, submucosal recurrence of rectal neoplasms

Reprint requests
Seiji Ito Department of Surgery II, Nagoya University School of Medicine 65 Turumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
September 20, 2000

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