title: [A Case of Demonstrating the Difficulties in Deciding How to Manage the Clinical Results after Rectal Resection].
abstract: It is important in the clinical setting to integrate all of the findings when diagnosing and making treatment decisions. We report a case of particular interest for managing cancer patients. A 69-year-old man underwent endoscopic resection for an Rb rectal tumor. The tumor showed a positive vertical margin and required laparoscopy-assisted super low anterior resection with ileostomy for histopathological stage Ⅰrectal cancer. His postoperative course was uneventful. The follow-up computed tomography (CT) scan revealed a tumor locating close to the left common iliac artery. Although positron emission tomography (PET) showed 18F-fluorodeoxyglucose (FDG) accumulation in the tumor, none of the other clinical findings indicated a recurrence of rectal cancer. FDG is not specific to malignant neoplasias, but the location of the tumor and the FDG uptake suggested the possibility of malignancy. No other tests found any evidence of a recurrence. Tumor resection was performed concurrently with ileostomy closure. Histopathology demonstrated it was an asymptomatic abscess in a lymph node. Tumor recurrence and metastases have to be kept in mind even if the primary lesion is in an early stage. This case shows the difficulty in deciding how to manage patients when clinical results are not consistent, especially in cases needing surgical procedures.
authors.affiliation: Dept. of Surgical Oncology, Osaka City University Graduate School of Medicine.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nagashima
authors.forename: Masatsune
authors.initials: M
authors.lastname: Shibutani
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Maeda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nagahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtani
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Sakurai
authors.forename: Sadaaki
authors.initials: S
authors.lastname: Yamazoe
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Amano
authors.forename: Naoshi
authors.initials: N
authors.lastname: Kubo
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ohira
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000038:Abscess / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012008:Recurrence