Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan.
World J Surg Oncol. 2021 Sep 3;19(1):269. doi: 10.1186/s12957-021-02382-4.
Pedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis.
A 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 μm from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery.
Additional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature.
带蒂息肉比无蒂早期结直肠癌更有可能完全切除，且很少需要额外的手术。我们遇到了一位带蒂的早期结直肠癌患者，其组织学类型为具有淋巴侵犯的低分化腺癌。我们进行了额外的肠切除术，并发现了淋巴结转移。
一位 43 岁女性因粪便潜血试验阳性而行结肠镜检查。结肠镜检查发现降结肠有一个 20mm 的带蒂息肉，并进行了内镜下切除。组织病理学检查显示非实体型低分化腺癌。病变侵犯黏膜下层（距黏膜肌层 3500μm）并伴有淋巴侵犯。尽管该癌症处于早期阶段，但患者被认为存在淋巴结转移的高风险。她被转至我院，接受了肠切除术。尽管她的内镜下切除后无残留癌，但在一个区域淋巴结中发现了转移性病变。患者正在接受术后辅助化疗，第二次手术后 3 个月尚未发现复发迹象。
对于带蒂息肉和多个淋巴结转移高危因素（如低分化腺癌和淋巴侵犯）的患者，建议进行额外的肠切除术。我们遇到了这样一位确实有淋巴结转移的患者；本文报告了她的病例，并进行了文献复习。
