Minute Early Cancer in Rectum (8 mm in Size and sm1 in Depth of Invasion) with Synchronous Liver Metastasis

Atsushi Nanashima, Takashi Hisamatsu*, Terumitsu Sawai, Hiroaki Tohyama**, Tohru Nakagoe and Takeshi Nagayasu

Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
*Department of Surgery, Izumikawa Hospital
**First Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences

A 69-year old man was admitted to our hospital with upper abdominal pain caused by the reflux esophagitis. An abdominal CT scan showed a 4 cm cystic liver tumor in segment S7/8, and colonoscopy revealed an 8 mm early flat-type (IIa+IIc) cancer with central depression and fold convergence in the recto-sigmoid area. Invasive colorectal carcinoma with liver metastasis was suspected, and high anterior resection of the rectum with D2 lymphadenectomy and partial hepatectomy were performed simultaneously. Histological examination revealed the moderately differentiated adenocarcinoma with slight invasion of the submucosal layer (sm1) and venous infiltration, but no lymph node metastasis. The liver tumor with central necrosis showed histological findings similar to those of the primary colorectal carcinoma. The pathological TNM stage according to the system of the Japanese Society for Cancer of the Colon and Rectum was stage IV, and surgical curability was B. We consider this case to be rare and valuable because of its rarity.

Key words
early colorectal carcinoma, flat-type, liver metastasis

Reprint requests
Atsushi Nanashima Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
December 19, 2003

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