Korean J Gastroenterol.  2013 May;61(5):286-289. 10.4166/kjg.2013.61.5.286.

Repeatedly Recurrent Colon Cancer Involving the Appendiceal Orifice after Endoscopic Piecemeal Mucosal Resection: A Case Report

• Sekiguchi
• Matsuda T
• Sekine S
• Sakamoto T
• Nakajima T
• Kushima R
• Akasu T
• Saito Y

• KMID: 1501652
• DOI: http://doi.org/10.4166/kjg.2013.61.5.286

Abstract

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.

Keyword

Appendiceal orifice; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection; Laparoscopic assisted colectomy; Local recurrence

MeSH Terms

Adenocarcinoma/*diagnosis/pathology/surgery
Aged
Appendiceal Neoplasms/complications
Colectomy
Colonic Neoplasms/*diagnosis/pathology/surgery
Colonoscopy
Humans
Intestinal Mucosa/pathology
Male
Neoplasm Recurrence, Local
Recurrence

Figure

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  Fig. 1. (A) Conventional colonoscopy finding. A 25 mm cecal sessile tumor spreading to the appendiceal orifice was revealed. (B) Magnifying chromoendoscopy with crystal violet staining. A noninvasive pattern was disclosed. (C) Endoscopic finding after endoscopic piecemeal resection of the tumor showing macroscopically no residual tumor.

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  Fig. 2. (A) Follow-up colonoscopy finding. The third recurrent tumor, 10 mm in size, was detected at the site of the initial endoscopic piecemeal mucosal resection. (B) Magnifying chromoendoscopy with crystal violet staining. A noninvasive pattern was shown.

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  Fig. 3. (A) The surgically resected specimen. The recurrent tumor was seen in the appendiceal orifice (arrowheads). (B) Histopathological examination of surgically resected specimen. Well differentiated adenocarcinoma in the cecum and the appendix was revealed (H&E,×40). (C) The assessment of muscularis mucosae with desmin staining (arrowheads). The disruption of the muscularis mucosae and the submucosal invasion of the tumor were demonstrated (Desmin staining, ×40).

Reference

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