Pedunculated polyp of early sigmoid colon cancer with invasive micropapillary carcinoma.
A 64-year-old man was admitted to Dongo Hospital (Nara, Japan) with colonic cancer, following the onset of abdominal pain, diarrhea and fever. A pedunculated polyp was detected in the sigmoid colon by colonoscopy, and laparoscopy-assisted sigmoidectomy with regional lymph node resection was performed. Histopathologically, the tumor exhibited massive invasion of the submucosa, and multiple lymph node metastases were detected. The tumor mainly consisted of a micropapillary component. Immunohistochemically, MUC1 was expressed at the stromal edge of the micropapillary component and showed the characteristic 'inside-out' pattern of a micropapillary carcinoma. The multiple lymph node metastases were predominantly composed of carcinoma with a micropapillary pattern. Our case suggests that when a micropapillary component is identified in a pre-operative biopsy specimen, even for a pedunculated early colorectal cancer, the extent of surgical resection should be carefully considered due to the high potential for nodal metastasis.
Sonoo
Hiroshi
H
Department of Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka 599-8247, Japan. h_sonoo@seichokai.or.jp
Kameyama
Masao
M
Inatugi
Naoki
N
Nonomura
Akitaka
A
Enomoto
Yasunori
Y
D002291:Carcinoma, Papillary / Q000556:secondary* / Q000628:therapy; D003110:Colonic Neoplasms / Q000473:pathology* / Q000628:therapy; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D003131:Combined Modality Therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012811:Sigmoid Neoplasms / Q000473:pathology* / Q000628:therapy