title: [A Case of Concurrent Cancer in a Giant Rectal Villous Adenoma That Resulted in Extensive Lymph Node Metastases].
abstract: The patient was a 72-year-old man. Colonoscopy revealed a circumferential villous tumor with granular aggregates extending from the rectosigmoid (RS) to the lower rectum (Rb). Although most portions were indicative of a villous adenoma, a reddish coarse region at the upper rectum (Ra) was diagnosed as a concurrent adenocarcinoma based on biopsies. Consequently, we performed laparoscopy-assisted intersphincteric resection (ISR) and D3 lymph node dissection. Pathological diagnosis revealed multiple lymph node (LN) metastases, including ones at the root of the inferior mesenteric artery (IMA). Adjuvant chemotherapy was administered with XELOX. However, computed tomography (CT) and positron emission tomography (PET) conducted 6 months after surgery revealed recurrent LN metastasis in the mesosigmoid ie, extra-regional LN metastasis. Therefore, chemotherapy was reinitiated with a FOLFIRI-based regimen. Metastases were observed in the lateral LNs and the para-aortic LNs 9 months after surgery, and in the left supraclavicular LNs 12 months after surgery. Herein, we report a rare case of cancer concurrent with a giant villous adenoma, which resulted in extensive LN metastases.
authors.affiliation: Dept. of Gastroenterological Surgery Graduate School of Medicine, Osaka University.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Taishi
authors.initials: T
authors.lastname: Hata
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hiraki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeyama
authors.forename: Ryoji
authors.initials: R
authors.lastname: Nonaka
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D018253:Adenoma, Villous / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D010071:Oxaloacetates; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D012008:Recurrence
chemical_list: D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil