Rectal cancer with distally spreading intramural metastasis: A case report and review of the literature

Kiminori Yanagisawa, Hidekazu Takahashi, Norikatsu Miyoshi, Naotsugu Haraguchi, Junichi Nishimura, Taishi Hata, Chu Matsuda, Hirofumi Yamamoto, Tsunekazu Mizushima, Yuichiro Doki, Masaki Mori

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Intramural metastasis (IM) is common in esophageal cancer, and it is an important factor in determining the resection area and tumor malignancy. However, IM is rare in rectal cancer; therefore, little is known about IM in rectal cancer, and the clinical significance remains unclear. Case Presentation: We describe a case of rectal cancer with distally spreading IM. A 58-year-old man consulted a primary care physician, with a chief complaint of constipation; tests revealed a high carcinoembryonic antigen value. A colonoscopy revealed a type 2, advanced rectal tumor, which covered two-thirds of the circumference of the upper rectum. In addition, 3 protruding lesions were observed under the normal mucosa on the anal side of the primary tumor. A laparoscopic low anterior resection was performed. Pathologic findings showed that the primary tumor was a moderate-to-well-differentiated adenocarcinoma with a cribriform structure. The 3 lesions on the anal side found under normal mucosa were separate from the primary tumor, but morphologically similar to the primary adenocarcinoma; therefore, these were diagnosed as IMs. Based on a review of previous case reports, rectal carcinomas were often accompanied by vascular invasions and lymph-node metastases. Moreover, in rectal cancer, tumors with IMs often show vascular invasion. Therefore, we assumed that IM could be a marker of poor prognosis. Conclusion: This study revealed that, in surgery, detection of a distally spreading IM is an important finding for determining the optimal surgical resection margin.

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalInternational Surgery
Volume103
Issue number1-2
DOIs
Publication statusPublished - 2019

All Science Journal Classification (ASJC) codes

  • Surgery

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