Abstract
A 56-year-old man presented with intermittent rectal bleeding of six months' duration. Colonoscopy revealed three left colon polyps, one of which harbored adenocarcinoma. Endoscopic mucosal resection (band-assisted colonoscopic polypectomy) was successful. Endoscopic ultrasonography did not demonstrate any local or regional spread; however, abdominal computed tomography (CT) scan raised suspicion of an isolated metastasis to the liver. The patient's mother had recently died from metastatic colorectal cancer. When presented with the options of no surgery, postendoscopic mucosal resection, and CT-directed needle biopsy of the suspected isolated metastasis to the liver versus segmental resection of the flat adenoma site and wedge resection of the liver lesion for the maximum chance of a surgical cure, the patient opted for the surgical approach. Histopathology revealed no evidence of malignancy in the rectosigmoid colon, pericolonic lymph, or liver specimen. Awareness of increased risk of early cancer in flat adenomas with central depression is important because prompt recognition can lead to curative therapy.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adachi M., Muto T., Okinaga K., Morioka Y. Clinicopathologic features of the flat adenoma. Dis Colon Rectum. 1991 Nov;34(11):981–986. doi: 10.1007/BF02049961. [DOI] [PubMed] [Google Scholar]
- Inoue H., Takeshita K., Hori H., Muraoka Y., Yoneshima H., Endo M. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc. 1993 Jan-Feb;39(1):58–62. doi: 10.1016/s0016-5107(93)70012-7. [DOI] [PubMed] [Google Scholar]
- Jaramillo E., Watanabe M., Slezak P., Rubio C. Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc. 1995 Aug;42(2):114–122. doi: 10.1016/s0016-5107(95)70066-8. [DOI] [PubMed] [Google Scholar]
- Muto T., Kamiya J., Sawada T., Konishi F., Sugihara K., Kubota Y., Adachi M., Agawa S., Saito Y., Morioka Y. Small "flat adenoma" of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum. 1985 Nov;28(11):847–851. doi: 10.1007/BF02555490. [DOI] [PubMed] [Google Scholar]
- Van Os E. C., Gostout C. J., Geller A., Ahlquist D. A., Batts K. P., Wolff B. G. Band ligation-assisted endoscopic resection of a flat rectal adenoma containing infiltrating adenocarcinoma. Gastrointest Endosc. 1997 Mar;45(3):322–324. doi: 10.1016/s0016-5107(97)70283-9. [DOI] [PubMed] [Google Scholar]
- Watanabe T., Muto T., Sawada T., Miyaki M. Flat adenoma as a precursor of colorectal carcinoma in hereditary nonpolyposis colorectal carcinoma. Cancer. 1996 Feb 15;77(4):627–634. doi: 10.1002/(sici)1097-0142(19960215)77:4<627::aid-cncr7>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]