Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

Abstract

This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann’s procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.

Intramural cancer recurrence in the rectum after curative surgery for proximal sigmoid colon cancer: a case report

“…Intramural cancer lesions, which usually grow as SMT-like lesions, are di cult to identify on colonoscopy as long as they result in mucosal changes. In fact, there are only a few case reports of the intramural spread of colorectal cancer that could be diagnosed via colonoscopy [7,8]. Furthermore, signi cant changes in intramural lesions at short intervals, such as in our case, were also observed in a previous report, which reported the appearance of intramural lesions only 5 weeks after negative ndings on initial coloscopy [3].…”

Intramural cancer recurrence in the rectum after curative surgery for proximal sigmoid colon cancer: a case report

“…This type of recurrence due to distant DIS occurs from vessel (lymphatic and venous) invasion, although cancer cell implantation from an inadequate surgical procedure may result in intramural recurrence near the primary surgical site [ 2 , 3 , 7 ]. Moderate to severe venous invasion was observed in both the primary and recurrent tumors in our case.…”

“…Intramural cancer lesions, which usually grow as SMT-like lesions, are difficult to identify on colonoscopy as long as they result in mucosal changes. In fact, there are only a few case reports of the intramural spread of colorectal cancer that could be diagnosed via colonoscopy [ 7 , 8 ]. Furthermore, significant changes in intramural lesions at short intervals, such as in our case, were also observed in a previous report, which reported the appearance of intramural lesions only 5 weeks after negative findings on initial colonoscopy [ 3 ].…”