A Case of Rectal Carcinoid Tumor 4 mm in Size with Lymph Node Metastasis

Shigeyoshi Yamanaga, Hiroshi Yokomizo, Michio Hifumi¹⁾, Toshimi Satou²⁾, Kouji Hayashi and Toshihiko Hirata

Department of Surgery, Department of Gastroenterology¹⁾ and Department of Pathology²⁾, Japanese Red Cross Kumamoto Hospital

A 58-year-old man with a submucosal tumor in the rectum Rb area found in a medical examination underwent endoscopic submucosal dissection (ESD) due to the tumor being clinically suspected of being a rectal carcinoid. Histologically, the 4 mm tumor had negative vertical and horizontal margins but accompanied minimal vascular invasion. The man underwent additional surgery after providing informed consent. Histological examination of the surgical specimen showed lymph node metastasis at station 251 (Japanese Classification of Colorectal Carcinoma, 7th Edition). If a patient with a rectal carcinoid presents findings such as a tumor exceeding 10 mm in size, invasion deeper than the muscularis propria, a central depression, a contour surface, and vascular invasion, additional surgery and careful follow-up are necessary. For tumors less than 5 mm in size, the indication for additional surgery is controversial because almost all cases in this subgroup has no lymph node metastasis and quality of life (QOL) may be impaired by additional intervention. As seen in this case, for a rectal carcinoid with vascular invasion, additional surgery and careful follow-up are necessary, regardless of lesion size.

Key words
rectal carcinoid, lymph node metastasis, vascular invasion

Reprint requests
Shigeyoshi Yamanaga Department of Surgery, Japanese Red Cross Kumamoto Hospital
2-1-1 Nagamine Minami, Kumamoto, 861-8520 JAPAN

Accepted
December 17, 2008

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