A Case of Descending Colon Cancer with Submucosal Invasion with Paraaortic Lymph Node Metastasis

Eiji Sunami, Satoshi Suzuki, Takeshi Mishina, Chizuko Kanbayashi, Masahiro O-taki, Masato Nakajima and Yo-ichi Matsubara

Department of Surgery, Tsuruoka Municipal Shonai Hospital

We reported a rare case of descending colon cancer with submucosal invasion and paraaortic lymph node metastasis. A 55-year-old man underwent colonoscopy for the purpose of screening, and was diagnosed with subpedunculated polyp of the descending colon measuring 10 mm in diameter, necessitating colonoscopic polypectomy. The polypectomised specimen showed well-differentiated adenocarcinoma with sm1 invasion. The tumor edge of the specimen was close to the cut margin, so we considered this case an indication for additional colonic resection. Laparotomy showed extensive lymph node swelling from the paracolic to the paraaortic lymph nodes, diagnosed as metastasis by frozen section, necessitating palliative partial D-colectomy with D1 dissection. The resected specimen showed only regenerative epithelium and no remnant cancer tissue. Adjuvant chemotherapy using 5FU and Isovolin was started on postoerative day 14. After 4 course of chemotherapy, paraaortic lymphnode metastasis disappeared, and chemotherapy was evaluated complete response by abdominal computed tomography. Reports of colorectal cancer with submucosal invasion and paraaortic lymphnode matastasis are, to our knowledge, few.

Key words
descending colon cancer, submucosal invasion, paraaortic lymphnode metastasis

Reprint requests
Eiji Sunami Department of Surgery, Nanbugo General Hospital
1404-1 Muramatu-machi, Niigata, 959-1700 JAPAN

Accepted
September 22, 2004

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