TY - JOUR
T1 - Rectal cancer with distally spreading intramural metastasis
T2 - A case report and review of the literature
AU - Yanagisawa, Kiminori
AU - Takahashi, Hidekazu
AU - Miyoshi, Norikatsu
AU - Haraguchi, Naotsugu
AU - Nishimura, Junichi
AU - Hata, Taishi
AU - Matsuda, Chu
AU - Yamamoto, Hirofumi
AU - Mizushima, Tsunekazu
AU - Doki, Yuichiro
AU - Mori, Masaki
N1 - Funding Information:
The authors have no conflicts of interest to declare. This study was performed according to the ethical standards of the Declaration of Helsinki. The patient provided informed consent for the inclusion of data in this report.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
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U2 - 10.9738/INTSURG-D-18-00003.1
DO - 10.9738/INTSURG-D-18-00003.1
M3 - Review article
AN - SCOPUS:85069849863
VL - 103
SP - 21
EP - 26
JO - International Surgery
JF - International Surgery
SN - 0020-8868
IS - 1-2
ER -